Healthcare Provider Details

I. General information

NPI: 1568537769
Provider Name (Legal Business Name): JAY ANN SHOP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 COUNTY LINE RD
HUNTINGDON VALLEY PA
19006-1738
US

IV. Provider business mailing address

1954 COUNTY LINE RD
HUNTINGDON VALLEY PA
19006-1738
US

V. Phone/Fax

Practice location:
  • Phone: 215-942-0120
  • Fax: 215-942-0130
Mailing address:
  • Phone: 215-942-0120
  • Fax: 215-942-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number6000004961
License Number StatePA

VIII. Authorized Official

Name: MS. FARRELL FRIEDENBERG
Title or Position: PRESIDENT
Credential: CMF
Phone: 215-942-0120