Provider Demographics
NPI:1174531339
Name:EAGLE MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:EAGLE MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:908-730-8000
Mailing Address - Street 1:373 PITTSTOWN RD
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867
Mailing Address - Country:US
Mailing Address - Phone:908-730-8000
Mailing Address - Fax:908-730-6005
Practice Address - Street 1:373 PITTSTOWN RD
Practice Address - Street 2:
Practice Address - City:PITTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08867
Practice Address - Country:US
Practice Address - Phone:908-730-8000
Practice Address - Fax:908-730-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJEAG100168341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3021203Medicaid
NJ203828Medicare ID - Type Unspecified