Provider Demographics
NPI:1437152725
Name:PENN YORK MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:PENN YORK MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:REXFORD
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-773-3622
Mailing Address - Street 1:69 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2914
Mailing Address - Country:US
Mailing Address - Phone:607-773-3622
Mailing Address - Fax:670-773-0063
Practice Address - Street 1:69 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2914
Practice Address - Country:US
Practice Address - Phone:607-773-3622
Practice Address - Fax:670-773-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01019736Medicaid
NY0152450001Medicare ID - Type Unspecified