MEDICARE: EMMANUEL MEDICAL EQUIPMENT SUPPLY

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	3662998	PA

General Provider Information

NPI Number	:	1477699759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL MEDICAL EQUIPMENT SUPPLY

Provider Business Mailing Address
First Line	:	1986 MERLIN RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3844
Country	:	US
Telephone Number	:	215-934-5181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1986 MERLIN RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3844
Country	:	US
Telephone Number	:	215-934-5181
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. NINAN KOSHY
Credential	:
Telephone Number	:	215-934-5181

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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