Provider Demographics
NPI:1083104467
Name:MY STAR MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MY STAR MEDICAL TRANSPORTATION LLC
Other - Org Name:MY STARLIMOUSINE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:VASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-234-8513
Mailing Address - Street 1:7 STAR PLZ
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2017
Mailing Address - Country:US
Mailing Address - Phone:973-234-8513
Mailing Address - Fax:866-228-9772
Practice Address - Street 1:7 STAR PLZ
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2017
Practice Address - Country:US
Practice Address - Phone:973-234-8513
Practice Address - Fax:866-228-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
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
NJ=========Medicaid