Healthcare Provider Details

I. General information

NPI: 1114493277
Provider Name (Legal Business Name): EXPRESS ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EVERGREEN PL STE 805
EAST ORANGE NJ
07018-2017
US

IV. Provider business mailing address

248 REYNOLDS TER APT 3A
ORANGE NJ
07050-3341
US

V. Phone/Fax

Practice location:
  • Phone: 732-867-4418
  • Fax: 877-215-8914
Mailing address:
  • Phone: 732-867-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: WILKENSCOL PIERRE
Title or Position: CO-OWNER
Credential: MPA
Phone: 732-867-4418