Provider Demographics
NPI:1619385614
Name:MEDIRUSH, LLC.
Entity Type:Organization
Organization Name:MEDIRUSH, LLC.
Other - Org Name:MEDIRUSH EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-387-8335
Mailing Address - Street 1:38 BRUNSWICK WOODS DR FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5601
Mailing Address - Country:US
Mailing Address - Phone:732-387-8335
Mailing Address - Fax:732-387-8440
Practice Address - Street 1:38 BRUNSWICK WOODS DR FL 2
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-387-8335
Practice Address - Fax:732-387-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)