Provider Demographics
NPI:1568685733
Name:PEACEINVALIDCOACHINC.
Entity Type:Organization
Organization Name:PEACEINVALIDCOACHINC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-217-1550
Mailing Address - Street 1:845 BERGEN AVE
Mailing Address - Street 2:190
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4517
Mailing Address - Country:US
Mailing Address - Phone:201-217-1550
Mailing Address - Fax:201-217-1590
Practice Address - Street 1:1330 REV S HOWARD WOODSON JR WAY
Practice Address - Street 2:4
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4018
Practice Address - Country:US
Practice Address - Phone:609-656-2244
Practice Address - Fax:609-656-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
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
NJ7096801Medicaid