Provider Demographics
NPI:1699222406
Name:GARDEN STATE MEDICAL TRANSPORTATION, INC
Entity Type:Organization
Organization Name:GARDEN STATE MEDICAL TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CULIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:201-488-0170
Mailing Address - Street 1:214 STATE ST
Mailing Address - Street 2:SUITE 203-B
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5500
Mailing Address - Country:US
Mailing Address - Phone:201-488-0170
Mailing Address - Fax:201-488-0172
Practice Address - Street 1:214 STATE ST
Practice Address - Street 2:SUITE 203-B
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5500
Practice Address - Country:US
Practice Address - Phone:201-488-0170
Practice Address - Fax:201-488-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGARD00220343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6125701Medicaid
NJ1356469415OtherNATIONAL PROVIDER NUMBER
NJGARD00220OtherNJ DEPARTMENT OF HEALTH