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General NPI Number Information
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NPI Number | 1760519391
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Entity Type | Organization
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Legal Business Name | COMMUNITY DURABLE MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 4706 BLAKISTON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19136-1515
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Country | US
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Telephone | 215-331-9812
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Fax | 215-331-9816
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Provider Business Mailing Address
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Address Line | 3057 WINCHESTER AVE.
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City | PHILADELPHIA
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State | PA
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Zip | 19136
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Country | US
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Telephone | 215-331-9812
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Fax | 215-331-9816
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Authorized Official
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Title or Position | OWNER
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Name | MR. GERARD O'CONNOR
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Credential |
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Telephone | 215-331-9812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 6000004713
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License Number State | PA
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