Provider Demographics
NPI:1598927915
Name:EMSSTAR LLC
Entity Type:Organization
Organization Name:EMSSTAR LLC
Other - Org Name:EM-STAR AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-764-8803
Mailing Address - Street 1:300 DOMINO LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4352
Mailing Address - Country:US
Mailing Address - Phone:215-764-8803
Mailing Address - Fax:215-827-5608
Practice Address - Street 1:1601 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-4011
Practice Address - Country:US
Practice Address - Phone:215-764-8803
Practice Address - Fax:215-827-5608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMSSTAR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJEMST220153416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011955800001Medicaid
NJ0077488Medicaid