MEDICARE: ORTHOPEDIC SUPPLY 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134222474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC SUPPLY INC

Provider Business Mailing Address
First Line	:	9150 MARSHALL ST
Second Line	:	SUITE 7
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2217
Country	:	US
Telephone Number	:	215-677-6194
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 MARSHALL ST
Second Line	:	SUITE 7
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2217
Country	:	US
Telephone Number	:	215-677-6194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AKSANA A PERAKROSTAVA
Credential	:
Telephone Number	:	215-677-6194

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	09/29/2008

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Directions to “ORTHOPEDIC SUPPLY INC ” Practice Location

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