MEDICARE: EXPRESS HEALTH SERVICES, INC.

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	152WL0500X	Low Vision Rehabilitation Optometrist	56004928	NY
2	207R00000X	Internal Medicine Physician	231060	NY
3	246QM0706X	Medical Technologist	0165601	NY
4	208000000X	Pediatrics Physician	2338331	NY

General Provider Information

NPI Number	:	1215480447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	65 W MERRICK RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5709
Country	:	US
Telephone Number	:	516-986-5429
Fax Number	:	516-825-0112

Provider Business Practice Location Address
First Line	:	65 W MERRICK RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5709
Country	:	US
Telephone Number	:	516-986-5429
Fax Number	:	516-825-0112

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. LUCIEN G PRINCE
Credential	:	M.D, M.B.A., M.S.
Telephone Number	:	646-752-2642

Provider Enumeration Date	:	07/23/2016
Last Update Date	:	07/23/2016

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Directions to “EXPRESS HEALTH SERVICES, INC. ” Practice Location

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