Provider Demographics
NPI:1144254129
Name:PA MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:PA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISCEGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-745-0995
Mailing Address - Street 1:360 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1513
Mailing Address - Country:US
Mailing Address - Phone:518-745-0995
Mailing Address - Fax:518-745-0996
Practice Address - Street 1:360 QUAKER RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1513
Practice Address - Country:US
Practice Address - Phone:518-745-0995
Practice Address - Fax:518-745-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10045238OtherCDPHP PROVIDER #
NY989056OtherMVP PROVIDER#
NY01547268Medicaid
NYCU075OtherEMPIRE BLUE CROSS PROV#
NY000400458001OtherBSNENY PROVIDER NUMBER
NY0967300001Medicare ID - Type UnspecifiedPROVIDER NUMBER