MEDICARE: MED STAR SURGICAL & BREATHING EQUIPMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BC3200X	Customized Equipment (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134220205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED STAR SURGICAL & BREATHING EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1185 COMMERCE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5528
Country	:	US
Telephone Number	:	718-512-1960
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	10/15/2025

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