Provider Demographics
NPI:1386707065
Name:GALLANT MOBIL CARE INC
Entity type:Organization
Organization Name:GALLANT MOBIL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-969-2588
Mailing Address - Street 1:995 PORT READING AVE
Mailing Address - Street 2:
Mailing Address - City:PORT READING
Mailing Address - State:NJ
Mailing Address - Zip Code:07064-1037
Mailing Address - Country:US
Mailing Address - Phone:732-969-2588
Mailing Address - Fax:732-969-2012
Practice Address - Street 1:995 PORT READING AVE
Practice Address - Street 2:
Practice Address - City:PORT READING
Practice Address - State:NJ
Practice Address - Zip Code:07064-1037
Practice Address - Country:US
Practice Address - Phone:732-969-2588
Practice Address - Fax:732-969-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGALL00216343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7223501Medicaid
NJ7223501Medicaid