MEDICARE: DERKAT MEDICAL SUPPLIES 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

General Provider Information

NPI Number	:	1972937654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERKAT MEDICAL SUPPLIES INC.

Provider Business Mailing Address
First Line	:	1733 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3915
Country	:	US
Telephone Number	:	845-699-6480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1733 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3915
Country	:	US
Telephone Number	:	845-699-6480
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DERRICK W LILLY
Credential	:
Telephone Number	:	845-699-6480

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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