Provider Demographics
NPI:1891978417
Name:NORTHEAST MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:NORTHEAST MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GASIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-743-6267
Mailing Address - Street 1:757 LILY RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-5525
Mailing Address - Country:US
Mailing Address - Phone:215-743-6267
Mailing Address - Fax:215-743-8848
Practice Address - Street 1:2716 ORTHODOX ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1604
Practice Address - Country:US
Practice Address - Phone:215-743-6267
Practice Address - Fax:215-743-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016391680001Medicaid
5389920001Medicare NSC