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General NPI Number Information
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NPI Number | 1902139504
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Entity Type | Organization
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Legal Business Name | KINGSMOUNT INC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 2917 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19133-2802
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Country | US
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Telephone | 215-739-7463
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Fax | 215-739-7463
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Provider Business Mailing Address
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Address Line | 9808 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2190
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Country | US
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Telephone | 215-676-7463
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Fax | 215-676-1110
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Authorized Official
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Title or Position | MANAGER
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Name | SOFYA TAMARKIN
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Credential | C. PED,, MBA
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Telephone | 21530033355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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