Provider Demographics
NPI:1275936957
Name:X PORT MEDICAL SERVICE LLC
Entity Type:Organization
Organization Name:X PORT MEDICAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAZIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELSAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-202-3008
Mailing Address - Street 1:86 CHESTER AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5930
Mailing Address - Country:US
Mailing Address - Phone:862-202-3008
Mailing Address - Fax:908-259-5746
Practice Address - Street 1:86 CHESTER AVE
Practice Address - Street 2:1ST FL
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5930
Practice Address - Country:US
Practice Address - Phone:862-202-3008
Practice Address - Fax:908-259-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100595341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance