Provider Demographics
NPI:1487157087
Name:AIDEN FRANCIS TRANSPORTATION
Entity type:Organization
Organization Name:AIDEN FRANCIS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOSTAO
Authorized Official - Middle Name:PEMBELE
Authorized Official - Last Name:MBEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-251-1341
Mailing Address - Street 1:40 CONGER ST APT 801A
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3324
Mailing Address - Country:US
Mailing Address - Phone:424-251-1341
Mailing Address - Fax:
Practice Address - Street 1:40 CONGER ST APT 801A
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3324
Practice Address - Country:US
Practice Address - Phone:424-251-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM10237507702782172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicaid