Provider Demographics
NPI:1568537769
Name:JAY ANN SHOP INC
Entity Type:Organization
Organization Name:JAY ANN SHOP INC
Other - Org Name:JAY ANN INTIMATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:215-942-0120
Mailing Address - Street 1:1954 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1738
Mailing Address - Country:US
Mailing Address - Phone:215-942-0120
Mailing Address - Fax:215-942-0130
Practice Address - Street 1:1954 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1738
Practice Address - Country:US
Practice Address - Phone:215-942-0120
Practice Address - Fax:215-942-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000004961225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
287288PAOtherBLUE CROSS BLUE SHIELD
0002059000OtherPERSONAL CHOICE KEYSTONE
287288PAOtherBLUE CROSS BLUE SHIELD