Provider Demographics
NPI:1316506272
Name:CARDONA, BRANDON L (MEDICAL TRANSPORT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:CARDONA
Suffix:
Gender:M
Credentials:MEDICAL TRANSPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 STATE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5530
Mailing Address - Country:US
Mailing Address - Phone:973-995-7421
Mailing Address - Fax:
Practice Address - Street 1:354 STATE ST STE 9
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5530
Practice Address - Country:US
Practice Address - Phone:973-995-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ84-2065949Medicaid