Provider Demographics
NPI:1487738621
Name:JOSEPH REZK
Entity type:Organization
Organization Name:JOSEPH REZK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-344-8994
Mailing Address - Street 1:1231 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2545
Mailing Address - Country:US
Mailing Address - Phone:724-775-4292
Mailing Address - Fax:
Practice Address - Street 1:1231 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2545
Practice Address - Country:US
Practice Address - Phone:724-775-4292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH REZK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007774640017Medicaid
PA1184370011Medicare NSC