Provider Demographics
NPI:1407017502
Name:SUPERIOR INVALID COACH
Entity Type:Organization
Organization Name:SUPERIOR INVALID COACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-803-1210
Mailing Address - Street 1:324 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1903
Mailing Address - Country:US
Mailing Address - Phone:201-288-1600
Mailing Address - Fax:201-288-1662
Practice Address - Street 1:324 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1903
Practice Address - Country:US
Practice Address - Phone:201-288-1600
Practice Address - Fax:201-288-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSUPE005583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6290604Medicaid