Provider Demographics
NPI:1619222882
Name:JAY ANN SHOP, INC
Entity type:Organization
Organization Name:JAY ANN SHOP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:215-942-0120
Mailing Address - Street 1:2052 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1739
Mailing Address - Country:US
Mailing Address - Phone:215-942-0120
Mailing Address - Fax:215-942-0130
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:ATTN: BOO'S BOUTIQUE-JAY ANN INTIMATES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-728-2627
Practice Address - Fax:215-728-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000007318224900000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0484410002Medicare NSC