Provider Demographics
NPI:1063469153
Name:WOODBURY TLC TRANSPORT, INC
Entity Type:Organization
Organization Name:WOODBURY TLC TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-1146
Mailing Address - Street 1:575 WOODBURY GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4563
Mailing Address - Country:US
Mailing Address - Phone:856-256-1390
Mailing Address - Fax:856-256-0656
Practice Address - Street 1:575 WOODBURY GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4563
Practice Address - Country:US
Practice Address - Phone:856-256-1390
Practice Address - Fax:856-256-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ57259OtherAMERIGROUP
NJ1004473OtherHORIZON NJ HEALTH
NJ3295907Medicaid
NJ0000129000OtherIBC GROUP
NJ35615OtherAETNA
NJJ13285OtherHEALTHNET
NJ35615OtherAETNA
NJJ13285OtherHEALTHNET