Provider Demographics
NPI:1932301785
Name:MOBILE LIFE SUPPORT SERVICES . INC
Entity Type:Organization
Organization Name:MOBILE LIFE SUPPORT SERVICES . INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-952-8755
Mailing Address - Street 1:540 BORDENTOWN AVE
Mailing Address - Street 2:STE 4A
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1546
Mailing Address - Country:US
Mailing Address - Phone:732-952-8755
Mailing Address - Fax:732-952-8754
Practice Address - Street 1:540 BORDENTOWN AVE
Practice Address - Street 2:STE 4A
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1546
Practice Address - Country:US
Practice Address - Phone:732-952-8755
Practice Address - Fax:732-952-8754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM12120613416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport