Provider Demographics
NPI:1376913525
Name:HERNANDEZ MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:HERNANDEZ MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SULLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-427-4004
Mailing Address - Street 1:20-21 WAGARAW RD
Mailing Address - Street 2:BUILDING 37
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1324
Mailing Address - Country:US
Mailing Address - Phone:973-427-4004
Mailing Address - Fax:973-427-4224
Practice Address - Street 1:20-21 WAGARAW RD
Practice Address - Street 2:BUILDING 37
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1324
Practice Address - Country:US
Practice Address - Phone:973-427-4004
Practice Address - Fax:973-427-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1027863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport