Provider Demographics
NPI:1659865228
Name:AZALO MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:AZALO MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHAMAT
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AZALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-925-7091
Mailing Address - Street 1:922 BERGEN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3002
Mailing Address - Country:US
Mailing Address - Phone:201-443-7866
Mailing Address - Fax:201-451-5254
Practice Address - Street 1:922 BERGEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3002
Practice Address - Country:US
Practice Address - Phone:201-443-7866
Practice Address - Fax:201-451-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0942020343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)