Healthcare Provider Details

I. General information

NPI: 1760480743
Provider Name (Legal Business Name): JRSP CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 GAR HWY
SWANSEA MA
02777-4225
US

IV. Provider business mailing address

122 HAILES HILL RD
SWANSEA MA
02777-3604
US

V. Phone/Fax

Practice location:
  • Phone: 508-646-6400
  • Fax:
Mailing address:
  • Phone: 508-646-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1092840001
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number389254
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3369
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1538586
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1092840001
License Number StateMA

VIII. Authorized Official

Name: STEPHEN MICHEAL PUSCIZNA
Title or Position: MANAGER OWNER
Credential:
Phone: 508-646-6400