Provider Demographics
NPI:1194034371
Name:PATRIOT MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:PATRIOT MEDICAL SUPPLY, INC.
Other - Org Name:PATRIOT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRAYBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-821-9495
Mailing Address - Street 1:380 RED LION RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6451
Mailing Address - Country:US
Mailing Address - Phone:215-821-9495
Mailing Address - Fax:215-677-7801
Practice Address - Street 1:380 RED LION RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6451
Practice Address - Country:US
Practice Address - Phone:215-821-9495
Practice Address - Fax:215-677-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000008635332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies