Provider Demographics
NPI:1316294226
Name:EXPRESS MEDICAL DME LIMITED LIABILITY CORPORATION
Entity type:Organization
Organization Name:EXPRESS MEDICAL DME LIMITED LIABILITY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAVALLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-421-2143
Mailing Address - Street 1:1575 ROUTE 37 W
Mailing Address - Street 2:UNIT 9
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4962
Mailing Address - Country:US
Mailing Address - Phone:732-421-2143
Mailing Address - Fax:732-240-7240
Practice Address - Street 1:1575 ROUTE 37 W
Practice Address - Street 2:UNIT 9
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4962
Practice Address - Country:US
Practice Address - Phone:732-421-2143
Practice Address - Fax:732-240-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies