Provider Demographics
NPI:1801015094
Name:GERVASE B NEALON
Entity type:Organization
Organization Name:GERVASE B NEALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERVASE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-781-9111
Mailing Address - Street 1:1616 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-2610
Mailing Address - Country:US
Mailing Address - Phone:412-781-9111
Mailing Address - Fax:
Practice Address - Street 1:1616 MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-2610
Practice Address - Country:US
Practice Address - Phone:412-781-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4341130001Medicare NSC