Provider Demographics
NPI:1568115038
Name:RAMZIDDIN, ABUSSAMAA RASUL I (MEDICAL TRANSPORT)
Entity Type:Individual
Prefix:MR
First Name:ABUSSAMAA
Middle Name:RASUL
Last Name:RAMZIDDIN
Suffix:I
Gender:M
Credentials:MEDICAL TRANSPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5285
Mailing Address - Country:US
Mailing Address - Phone:609-477-2184
Mailing Address - Fax:
Practice Address - Street 1:207 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5285
Practice Address - Country:US
Practice Address - Phone:609-815-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJJ84KXF172A00000X, 347C00000X
NJ3636HJ342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes342000000XTransportation ServicesTransportation Network Company
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle