Organization
NORTHEAST MEDICAL SALES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMI L DANNECKER (SENIOR PARTNER)
(570) 965-0964
Entity
Organization
Contact information
Practice address
2354 OLD POST RD, SUITE 2, COPLAY, PA 18037-2461
(610) 262-3331
(610) 262-3399
Mailing address
315 JOHNSON RD, SPRINGVILLE, PA 18844-8019
(570) 965-0964
(570) 965-0964
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
6000004877
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016073300002
—
PA
01
—
1517547
GATEWAY/GATEWAY MEDICARE ASSURED
PA
01
—
39HA79
CAPITAL BLUE CROSS
PA
Enumeration date
02/18/2010
Last updated
09/21/2015
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