Organization
INDEPENDENT MOBILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES COSTANZO (PRESIDENT)
(570) 825-1277
Entity
Organization
Contact information
Practice address
147 1/2 AMBER LN, WILKES BARRE, PA 18702-6545
(570) 825-1277
(570) 825-1278
Mailing address
147 1/2 AMBER LN, WILKES BARRE, PA 18702-6545
(570) 825-1277
(570) 825-1278
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000005585
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000005585
—
PA
Enumeration date
12/04/2006
Last updated
04/15/2008
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