Provider Demographics
NPI:1174869176
Name:EOS MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:EOS MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-453-8367
Mailing Address - Street 1:29 S NEW YORK RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:215-453-8367
Mailing Address - Fax:610-200-5322
Practice Address - Street 1:29 S NEW YORK RD
Practice Address - Street 2:SUITE 900
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:215-453-8367
Practice Address - Fax:610-200-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA85648139332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies