Provider Demographics
NPI:1871731893
Name:METRO INSTALLATIONS MOBILITY PROVIDER INC
Entity type:Organization
Organization Name:METRO INSTALLATIONS MOBILITY PROVIDER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:973-220-7128
Mailing Address - Street 1:146 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1801
Mailing Address - Country:US
Mailing Address - Phone:862-520-1653
Mailing Address - Fax:973-206-6954
Practice Address - Street 1:146 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1801
Practice Address - Country:US
Practice Address - Phone:862-520-1653
Practice Address - Fax:973-206-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6588900001Medicare NSC