Healthcare Provider Details

I. General information

NPI: 1174869176
Provider Name (Legal Business Name): EOS MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S NEW YORK RD SUITE 900
GALLOWAY NJ
08205
US

IV. Provider business mailing address

29 S NEW YORK RD SUITE 900
GALLOWAY NJ
08205
US

V. Phone/Fax

Practice location:
  • Phone: 215-453-8367
  • Fax: 610-200-5322
Mailing address:
  • Phone: 215-453-8367
  • Fax: 610-200-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number85648139
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANA A DENNER
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 215-453-8367