Provider Demographics
NPI:1164722047
Name:ABDULATIF, FAREED DAHAB (TRANSPORTATION COMPA)
Entity Type:Individual
Prefix:MR
First Name:FAREED
Middle Name:DAHAB
Last Name:ABDULATIF
Suffix:
Gender:M
Credentials:TRANSPORTATION COMPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTH RIDGEWOOD RD.
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SO. ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079
Mailing Address - Country:US
Mailing Address - Phone:973-821-5446
Mailing Address - Fax:973-821-5447
Practice Address - Street 1:131 SO. HARRISON ST.
Practice Address - Street 2:
Practice Address - City:E. ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-821-5446
Practice Address - Fax:973-821-5447
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1256742341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6588506Medicaid