Provider Demographics
NPI:1467699074
Name:EXPRESS MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:EXPRESS MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:INOKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-988-2907
Mailing Address - Street 1:123 TOWN SQUARE PL
Mailing Address - Street 2:698
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1756
Mailing Address - Country:US
Mailing Address - Phone:201-988-2907
Mailing Address - Fax:718-355-9661
Practice Address - Street 1:123 TOWN SQUARE PL
Practice Address - Street 2:698
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1756
Practice Address - Country:US
Practice Address - Phone:201-988-2907
Practice Address - Fax:718-355-9661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANGEA GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-20
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies