Provider Demographics
NPI:1003976754
Name:JOSEPH REZK
Entity Type:Organization
Organization Name:JOSEPH REZK
Other - Org Name:REZK MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-344-8994
Mailing Address - Street 1:322 WARREN STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-254-1500
Mailing Address - Fax:814-254-1600
Practice Address - Street 1:322 WARREN STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-254-1500
Practice Address - Fax:814-254-1600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH REZK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007774640013Medicaid
PA1007774640013Medicaid