Provider Demographics
NPI:1407623283
Name:GROOMS, RASHAN L
Entity Type:Individual
Prefix:
First Name:RASHAN
Middle Name:L
Last Name:GROOMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 GORNIK DR
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-1604
Mailing Address - Country:US
Mailing Address - Phone:732-824-2024
Mailing Address - Fax:
Practice Address - Street 1:754 GORNIK DR
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-1604
Practice Address - Country:US
Practice Address - Phone:732-824-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)