Provider Demographics
NPI:1356469415
Name:GARDEN STATE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:GARDEN STATE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-439-1214
Mailing Address - Street 1:22 E QUACKENBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3055
Mailing Address - Country:US
Mailing Address - Phone:201-439-1214
Mailing Address - Fax:201-439-0377
Practice Address - Street 1:22 E QUACKENBUSH AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3055
Practice Address - Country:US
Practice Address - Phone:201-439-1214
Practice Address - Fax:201-439-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6125701Medicaid