Provider Demographics
NPI:1295958650
Name:AGC SERVICES
Entity type:Organization
Organization Name:AGC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-928-3428
Mailing Address - Street 1:336 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6323
Mailing Address - Country:US
Mailing Address - Phone:973-928-3428
Mailing Address - Fax:
Practice Address - Street 1:336 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6323
Practice Address - Country:US
Practice Address - Phone:973-928-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00033100343800000X, 344600000X, 347B00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered343800000XTransportation ServicesSecured Medical Transport (VAN)
Not Answered344600000XTransportation ServicesTaxi
Not Answered347B00000XTransportation ServicesBus
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ474 8107Medicaid
NJ607 850Medicare ID - Type Unspecified