Healthcare Provider Details

I. General information

NPI: 1073835039
Provider Name (Legal Business Name): NORTHEAST MEDICAL SALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 OLD POST RD SUITE 2
COPLAY PA
18037-2461
US

IV. Provider business mailing address

315 JOHNSON RD
SPRINGVILLE PA
18844-8019
US

V. Phone/Fax

Practice location:
  • Phone: 610-262-3331
  • Fax: 610-262-3399
Mailing address:
  • Phone: 570-965-0964
  • Fax: 570-965-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number6000004877
License Number StatePA

VIII. Authorized Official

Name: MRS. TAMMI L DANNECKER
Title or Position: SENIOR PARTNER
Credential:
Phone: 570-965-0964