Provider Demographics
NPI:1811562721
Name:GARDEN STATE EXECUTIVE TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:GARDEN STATE EXECUTIVE TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT /OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:551-246-4314
Mailing Address - Street 1:468 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2347
Mailing Address - Country:US
Mailing Address - Phone:551-246-4314
Mailing Address - Fax:
Practice Address - Street 1:468 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2347
Practice Address - Country:US
Practice Address - Phone:551-246-4314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle