MEDICARE: AKSANA A PERAKROSTAVA

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		PA

General Provider Information

NPI Number	:	1689688947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKSANA A PERAKROSTAVA

Provider Business Mailing Address
First Line	:	282 RIDGEWAY PLZ
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3513
Country	:	US
Telephone Number	:	215-820-8584
Fax Number	:	215-953-9814

Provider Business Practice Location Address
First Line	:	9150 MARSHALL ST
Second Line	:	SUITE #7
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2217
Country	:	US
Telephone Number	:	215-677-6194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	09/18/2008

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