Provider Demographics
NPI:1114928991
Name:NORTHEAST EXPRESS
Entity Type:Organization
Organization Name:NORTHEAST EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-494-3839
Mailing Address - Street 1:36017 BURBAGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-6703
Mailing Address - Country:US
Mailing Address - Phone:302-829-8312
Mailing Address - Fax:302-829-8320
Practice Address - Street 1:36017 BURBAGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-6703
Practice Address - Country:US
Practice Address - Phone:302-829-8312
Practice Address - Fax:302-829-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1993108896332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400444200Medicaid
DE0000981716Medicaid
DE0579700001Medicare NSC