Organization
PA MEDICAL SUPPLY INC
Active
Organization
PA MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN BISCEGLIA (PRESIDENT)
(518) 745-0995
Entity
Organization
Contact information
Practice address
360 QUAKER RD, QUEENSBURY, NY 12804-1513
(518) 745-0995
(518) 745-0996
Mailing address
360 QUAKER RD, QUEENSBURY, NY 12804-1513
(518) 745-0995
(518) 745-0996
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000400458001
BSNENY PROVIDER NUMBER
NY
05
—
01547268
—
NY
01
—
10045238
CDPHP PROVIDER #
NY
01
—
989056
MVP PROVIDER#
NY
01
—
CU075
EMPIRE BLUE CROSS PROV#
NY
Enumeration date
07/10/2006
Last updated
01/23/2012
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