Provider Demographics
NPI:1073104873
Name:MYLE NJ LLC
Entity Type:Organization
Organization Name:MYLE NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF STRATEGIC GROWTH
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-842-4342
Mailing Address - Street 1:20 COMMERCE DR STE 135
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3614
Mailing Address - Country:US
Mailing Address - Phone:917-842-4342
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE DR STE 135
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3614
Practice Address - Country:US
Practice Address - Phone:917-842-4342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)