Basic Information
Provider Information | |||||||||
NPI: | 1437154010 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MEDSTAR SURGICAL & BREATHING EQUIPMENT, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 220 W GERMANTOWN PIKE STE 250 | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH MEETING | ||||||||
State: | PA | ||||||||
PostalCode: | 194621437 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106306357 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 99 POWERHOUSE RD STE 205 | ||||||||
Address2: |   | ||||||||
City: | ROSLYN HEIGHTS | ||||||||
State: | NY | ||||||||
PostalCode: | 115772039 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7184602900 | ||||||||
FaxNumber: | 7184601900 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2005 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GRIGGS | ||||||||
AuthorizedOfficialFirstName: | STEPHEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 4072060040 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 335E00000X |   |   | N |   | Suppliers | Prosthetic/Orthotic Supplier |   | 332B00000X |   | NY | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 01428615 | 05 | NY |   | MEDICAID | 0076819700002 | 05 | PA |   | MEDICAID | 421188000 | 05 | MD |   | MEDICAID | 7786107 | 05 | NJ |   | MEDICAID |