Provider Demographics
NPI:1043437619
Name:PETER PAN TRANSPORT LLC
Entity Type:Organization
Organization Name:PETER PAN TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-445-0784
Mailing Address - Street 1:269 WILLARD PL
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-4485
Mailing Address - Country:US
Mailing Address - Phone:973-445-0784
Mailing Address - Fax:
Practice Address - Street 1:269 WILLARD PL
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4485
Practice Address - Country:US
Practice Address - Phone:973-445-0784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5327008Medicaid