Provider Demographics
NPI:1477540482
Name:DELAWARE VALLEY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:DELAWARE VALLEY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-796-7555
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455-0847
Mailing Address - Country:US
Mailing Address - Phone:718-796-7555
Mailing Address - Fax:516-566-2395
Practice Address - Street 1:159 FAIR ST
Practice Address - Street 2:
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455-2822
Practice Address - Country:US
Practice Address - Phone:718-796-7555
Practice Address - Fax:516-566-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02441550Medicaid
NY02441550Medicaid