Organization
PROFILE SHOP, INC.
Active
Parent organization
PROFILE SHOP, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROFILE SHOP, INC
Authorized official
DIANE L GESUALDI CMF (PRESIDENT)
(215) 355-5788
Entity
Organization
Contact information
Practice address
45 SECOND STREET PIKE, SUITE 300, SOUTHAMPTON, PA 18966-3806
(215) 355-5788
(215) 355-5778
Mailing address
3300 TILLMAN DR, SUITE 105, BENSALEM, PA 19020-2071
(215) 633-3461
(215) 633-3567
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000005802
PA
Other
Enumeration date
08/26/2011
Last updated
09/26/2012
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