Provider Demographics
NPI:1841535697
Name:MARCELLINO ENTERPRISES, INC. DBA AMRAMP
Entity type:Organization
Organization Name:MARCELLINO ENTERPRISES, INC. DBA AMRAMP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCELLINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-585-2308
Mailing Address - Street 1:16 TROUT RUN DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1175
Mailing Address - Country:US
Mailing Address - Phone:610-585-2308
Mailing Address - Fax:610-738-8375
Practice Address - Street 1:16 TROUT RUN DR
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1175
Practice Address - Country:US
Practice Address - Phone:610-585-2308
Practice Address - Fax:610-738-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6000006258Medicaid
PA0019582000001Medicaid
PAV797P-3115MOtherFEDERAL SUPPLY SCHEDULE CONTRACT