Organization
BOSOM BUDDIES, LLC
Active
Other names
Gie Gie Lingerie
Organization subpart
No
Provider details
NPI number
Authorized official
MISS REGINA MASTRANGELO CFM (OWNER)
(610) 296-7626
Entity
Organization
Contact information
Practice address
36 CHESTNUT RD, PAOLI, PA 19301-1565
(610) 296-7626
(610) 296-7620
Mailing address
36 CHESTNUT RD, PAOLI, PA 19301-1565
(610) 296-7626
(610) 296-7620
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
Z6860
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002039000
INDEPENDENCE BLUE CROSS
PA
01
—
1981984
HIGHMARK
PA
Enumeration date
05/10/2007
Last updated
08/01/2013
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