Provider Demographics
NPI:1780002576
Name:PHOTOMEDEX, INC.
Entity Type:Organization
Organization Name:PHOTOMEDEX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-619-3600
Mailing Address - Street 1:100 LAKESIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2316
Mailing Address - Country:US
Mailing Address - Phone:215-619-3600
Mailing Address - Fax:215-619-3209
Practice Address - Street 1:100 LAKESIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2316
Practice Address - Country:US
Practice Address - Phone:215-619-3600
Practice Address - Fax:215-619-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44415332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies