Provider Demographics
NPI:1962693630
Name:DELTA INVALID COACH
Entity type:Organization
Organization Name:DELTA INVALID COACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-906-1800
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07544-0325
Mailing Address - Country:US
Mailing Address - Phone:800-272-3746
Mailing Address - Fax:973-278-7797
Practice Address - Street 1:52 COURTLAND ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2947
Practice Address - Country:US
Practice Address - Phone:800-272-3746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDELT0003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7214804Medicaid