Provider Demographics
NPI:1649411059
Name:EXPRESS MEDICAL SUPPLY
Entity type:Organization
Organization Name:EXPRESS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT/CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:PUCCINI
Authorized Official - Middle Name:
Authorized Official - Last Name:INOKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-340-4579
Mailing Address - Street 1:3515 E TREMONT AVE # 222
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2002
Mailing Address - Country:US
Mailing Address - Phone:646-340-4579
Mailing Address - Fax:
Practice Address - Street 1:3515 E TREMONT AVE # 222
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2002
Practice Address - Country:US
Practice Address - Phone:646-340-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APLUS MEDICAL SUPPLY & EQUIPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies