Organization
LIBERTY MEDICAL MINORITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMBLYN JACKSON (MANAGING MEMBER)
(973) 405-5000
Entity
Organization
Contact information
Practice address
831 MAIN AVE, PASSAIC, NJ 07055-8400
(973) 405-5000
Mailing address
831 MAIN AVE, PASSAIC, NJ 07055-8400
(973) 405-5000
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
07/03/2008
Last updated
07/03/2008
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