Provider Demographics
NPI:1497927198
Name:PRIME MOBILITY ASSIST. VEHICLE INC
Entity Type:Organization
Organization Name:PRIME MOBILITY ASSIST. VEHICLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:L
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-435-3388
Mailing Address - Street 1:39 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2009
Mailing Address - Country:US
Mailing Address - Phone:201-435-3388
Mailing Address - Fax:201-435-5700
Practice Address - Street 1:39 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2009
Practice Address - Country:US
Practice Address - Phone:201-435-3388
Practice Address - Fax:201-435-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7694202Medicaid