MEDICARE: JAY ANN SHOP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	6000004961	PA

General Provider Information

NPI Number	:	1174713523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY ANN SHOP, INC.

Provider Business Mailing Address
First Line	:	1954 COUNTY LINE RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1738
Country	:	US
Telephone Number	:	215-942-0120
Fax Number	:	215-942-0130

Provider Business Practice Location Address
First Line	:	2052 COUNTY LINE RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1739
Country	:	US
Telephone Number	:	215-942-0120
Fax Number	:	215-942-0130

Authorized Official
Title or Position	:	OWNER
Name	:	FARRELL FRIEDENBERG
Credential	:
Telephone Number	:	215-942-0120

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	12/05/2017

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