Provider Demographics
NPI:1730110180
Name:LIFE STREAMS MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:LIFE STREAMS MEDICAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ETCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-523-4177
Mailing Address - Street 1:19 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1054
Practice Address - Country:US
Practice Address - Phone:973-523-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068155OtherMEDICARE PTAN