Provider Demographics
NPI:1811484447
Name:EXPRESS DIAGNOSTICS LLC
Entity type:Organization
Organization Name:EXPRESS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KINCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-928-8394
Mailing Address - Street 1:PO BOX 2877
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33568-2877
Mailing Address - Country:US
Mailing Address - Phone:813-928-7939
Mailing Address - Fax:888-482-2405
Practice Address - Street 1:100 FRANKLIN SQUARE DR STE 301B
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4109
Practice Address - Country:US
Practice Address - Phone:813-928-7939
Practice Address - Fax:888-482-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0011812291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory