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	225000000X	Orthotic Fitter	6000004961	PA
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0002059000	OTHER	PERSONAL CHOICE KEYSTONE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	287288PA	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1568537769
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	:	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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. FARRELL FRIEDENBERG
Credential	:	CMF
Telephone Number	:	215-942-0120

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	04/30/2025

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