Provider Demographics
NPI:1801690771
Name:VANDENBERG TRANSPORT LLC
Entity type:Organization
Organization Name:VANDENBERG TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAFAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-640-6340
Mailing Address - Street 1:21 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2025
Mailing Address - Country:US
Mailing Address - Phone:201-745-4245
Mailing Address - Fax:
Practice Address - Street 1:21 WALNUT LN
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2025
Practice Address - Country:US
Practice Address - Phone:973-640-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)