Provider Demographics
NPI:1528588019
Name:GOLDEN AGE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GOLDEN AGE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-499-1172
Mailing Address - Street 1:2 RALEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7906
Mailing Address - Country:US
Mailing Address - Phone:732-284-6020
Mailing Address - Fax:
Practice Address - Street 1:2 RALEIGH WAY
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7906
Practice Address - Country:US
Practice Address - Phone:732-284-6020
Practice Address - Fax:732-284-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid