Provider Demographics
NPI:1245436450
Name:MED STAR MEDICALTRANSPORT
Entity type:Organization
Organization Name:MED STAR MEDICALTRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ALEN
Authorized Official - Last Name:SASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-265-5692
Mailing Address - Street 1:439 FORT LEE RD
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605
Mailing Address - Country:US
Mailing Address - Phone:551-265-5692
Mailing Address - Fax:201-754-9756
Practice Address - Street 1:439 FORT LEE RD
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1132
Practice Address - Country:US
Practice Address - Phone:551-265-5692
Practice Address - Fax:201-754-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ554828554076050347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle