Provider Demographics
NPI:1073742151
Name:POMAC METRO IPA LLC
Entity Type:Organization
Organization Name:POMAC METRO IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRETER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:856-273-9636
Mailing Address - Street 1:365 C NEW ALBANY RD.
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057
Mailing Address - Country:US
Mailing Address - Phone:856-273-9636
Mailing Address - Fax:856-273-7886
Practice Address - Street 1:365 C NEW ALBANY RD.
Practice Address - Street 2:
Practice Address - City:MOORESTOWN.
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-273-9636
Practice Address - Fax:856-273-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment