MEDICARE: COMMUNITY EXPO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629757034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY EXPO LLC

Provider Business Mailing Address
First Line	:	366 HIGH CREST DR
Second Line	:
City	:	WEST MILFORD
State	:	NJ
Zip	:	07480-3740
Country	:	US
Telephone Number	:	770-312-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	366 HIGH CREST DR
Second Line	:
City	:	WEST MILFORD
State	:	NJ
Zip	:	07480-3740
Country	:	US
Telephone Number	:	770-312-2773
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NATASHA WINFREY
Credential	:
Telephone Number	:	770-312-2773

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/18/2023

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