Provider Demographics
NPI:1952425696
Name:BOOMERANG TRANSPORTATION INC.
Entity Type:Organization
Organization Name:BOOMERANG TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IOSIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-912-9444
Mailing Address - Street 1:901 MOUNTAIN AVE
Mailing Address - Street 2:ECHO PLAZA 2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3414
Mailing Address - Country:US
Mailing Address - Phone:973-912-9444
Mailing Address - Fax:973-912-9455
Practice Address - Street 1:901 MOUNTAIN AVE
Practice Address - Street 2:ECHO PLAZA 2ND FL
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3414
Practice Address - Country:US
Practice Address - Phone:973-912-9444
Practice Address - Fax:973-912-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBOO018343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1089561OtherHORIZON NJ HEALTH ID
NJ7661606Medicaid