MEDICARE: EXPLORER EXPRESS

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1255196564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPLORER EXPRESS

Provider Business Mailing Address
First Line	:	6809 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5828
Country	:	US
Telephone Number	:	718-238-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	6809 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5828
Country	:	US
Telephone Number	:	718-238-0224
Fax Number	:	718-238-0430

Authorized Official
Title or Position	:	MANAGER
Name	:	JUAN OLIVO
Credential	:
Telephone Number	:	917-204-8378

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/16/2024

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Directions to “EXPLORER EXPRESS ” Practice Location

Language	Start Address	Practice Location

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