Provider Demographics
NPI:1073399895
Name:ALTAY, MIRZA
Entity Type:Individual
Prefix:
First Name:MIRZA
Middle Name:
Last Name:ALTAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 STELTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1113
Mailing Address - Country:US
Mailing Address - Phone:973-216-9706
Mailing Address - Fax:
Practice Address - Street 1:4953 STELTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1113
Practice Address - Country:US
Practice Address - Phone:973-216-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)