Provider Demographics
NPI:1922279249
Name:ASSIGN MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:ASSIGN MEDICAL TRANSPORT
Other - Org Name:AMT INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTSFORD
Authorized Official - Middle Name:EDISON
Authorized Official - Last Name:IRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-996-0029
Mailing Address - Street 1:299 W FORT LEE RD
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1288
Mailing Address - Country:US
Mailing Address - Phone:201-996-0029
Mailing Address - Fax:201-996-0466
Practice Address - Street 1:299 W FORT LEE RD
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1288
Practice Address - Country:US
Practice Address - Phone:201-996-0029
Practice Address - Fax:201-996-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJASSI00062343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7320507Medicaid