Provider Demographics
NPI:1295407237
Name:NORTHEAST EXPRESS COURIER SERVICE, LLC
Entity Type:Organization
Organization Name:NORTHEAST EXPRESS COURIER SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-310-1964
Mailing Address - Street 1:1428 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-3710
Mailing Address - Country:US
Mailing Address - Phone:518-310-1964
Mailing Address - Fax:
Practice Address - Street 1:1428 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3710
Practice Address - Country:US
Practice Address - Phone:518-310-1964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06277494Medicaid