Provider Demographics
NPI:1295366789
Name:EVERGREEN TRANSPORT;LLC
Entity Type:Organization
Organization Name:EVERGREEN TRANSPORT;LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WAHID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIBLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-207-5893
Mailing Address - Street 1:8 TREEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CLIFFWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07721-1268
Mailing Address - Country:US
Mailing Address - Phone:732-207-5893
Mailing Address - Fax:732-777-1449
Practice Address - Street 1:680 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3120
Practice Address - Country:US
Practice Address - Phone:732-207-5893
Practice Address - Fax:732-777-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle