| NPI |
1891978417 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name |
NORTHEAST MEDICAL SUPPLIES LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider First Line Business Practice Location Address |
2716 ORTHODOX ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address City Name |
PHILADELPHIA |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
PA |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
191371604 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
2157436267 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
2157438848 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
12/6/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
12/6/2007 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
GASIEWSKI |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Authorized Official First Name |
WILLIAM |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Authorized Official Title or Position |
PRESIDENT |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Authorized Official Telephone Number |
2157436267 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
332B00000X |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Other Provider Identifier 1 |
1016391680001 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 1 |
05 |
The State code in the location of the provider
being identified. |
| Other Provider Identifier State 1 |
PA |
|
| Is Organization Subpart |
N |
The date the provider was assigned a unique identifier (assigned an NPI). |