Provider Demographics
NPI:1043315419
Name:JOSEPH REZK
Entity Type:Organization
Organization Name:JOSEPH REZK
Other - Org Name:PUNXSY/REZK MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:REZK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:814-344-8994
Mailing Address - Street 1:115 SOUTH MAIN STREET, PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-0520
Mailing Address - Country:US
Mailing Address - Phone:814-344-8994
Mailing Address - Fax:814-344-2093
Practice Address - Street 1:115 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722
Practice Address - Country:US
Practice Address - Phone:814-344-8994
Practice Address - Fax:814-344-2093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUNXSY MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA80586214332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007774640007Medicaid
PA1007774640007Medicaid