=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730403312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS MEDICAL SUPPLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2010
-----------------------------------------------------
Last Update Date | 03/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9490 218TH ST
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11428-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-464-9740
-----------------------------------------------------
Fax | 718-464-9741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9490 218TH ST
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11428-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-464-9740
-----------------------------------------------------
Fax | 718-464-9741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. DORIS SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-464-9740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------