Organization
MADISON INVALID COACH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IBRAHIM SHAZELI (PRESIDENT)
(973) 680-1121
Entity
Organization
Contact information
Practice address
259 HOOVER AVE, SECOND FLOOR REAR, BLOOMFIELD, NJ 07003-3763
(973) 680-1121
(973) 680-1149
Mailing address
259 HOOVER AVE, SECOND FLOOR REAR, BLOOMFIELD, NJ 07003-3763
(973) 680-1121
(973) 680-1149
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
MAD04076
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6385206
—
NJ
Enumeration date
10/02/2006
Last updated
08/22/2020
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