Provider Demographics
NPI:1356022107
Name:MODELED LIGHT TRANSPORT, LLC
Entity type:Organization
Organization Name:MODELED LIGHT TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUINYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-213-7277
Mailing Address - Street 1:6 KILNVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-2118
Mailing Address - Country:US
Mailing Address - Phone:856-213-7277
Mailing Address - Fax:
Practice Address - Street 1:6 KILNVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-2118
Practice Address - Country:US
Practice Address - Phone:856-213-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle