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General NPI Number Information
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NPI Number | 1679691711
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Entity Type | Organization
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Legal Business Name | ULYSEES GAMMAGE JR
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 6037 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3207
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Country | US
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Telephone | 215-776-0981
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Fax | 215-224-6611
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Provider Business Mailing Address
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Address Line | 6037 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3207
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Country | US
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Telephone | 215-776-0981
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Fax | 215-224-6611
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Authorized Official
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Title or Position | OWNER
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Name | MR. ULYSEES GAMMAGE JR.
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Credential |
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Telephone | 215-776-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 6000005706
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License Number State | PA
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