Provider Demographics
NPI:1467653956
Name:COMMUNITY MEDICAL TRANSPORTERS, LLC.
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL TRANSPORTERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GACUTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-236-6555
Mailing Address - Street 1:130 W WHITE HORSE PIKE
Mailing Address - Street 2:4A
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2028
Mailing Address - Country:US
Mailing Address - Phone:856-236-6555
Mailing Address - Fax:856-258-9341
Practice Address - Street 1:130 W WHITE HORSE PIKE
Practice Address - Street 2:4A
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2028
Practice Address - Country:US
Practice Address - Phone:856-236-6555
Practice Address - Fax:856-258-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01548652Medicaid