Chesapeake Medical Supply, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

6000004048 Issued in PA

Legal business name

CHESAPEAKE MEDICAL SUPPLY, INC

Doing business as

Philadelphia Rehab

Practice address

937 Chester Pike
4M
Prospect Park, PA 19076-2331

Phone

(215) 755-0255

NPI assigned

Feb 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David E Bouslog, ATP

Title

President

Phone

(215) 755-0255

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Philadelphia Rehab Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1053452326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "937 CHESTER PIKE",
            "address_2": "4M",
            "city": "PROSPECT PARK",
            "state": "PA",
            "postal_code": "190762331",
            "telephone_number": "215-755-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "937 CHESTER PIKE",
            "address_2": "4M",
            "city": "PROSPECT PARK",
            "state": "PA",
            "postal_code": "190762331",
            "telephone_number": "215-755-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE MEDICAL SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "BOUSLOG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-755-0255",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "6000004048",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012883280002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000538218",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philadelphia Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathleen Bartus, LPC
• Kylie Bedwell
• Christy Marie Benjamin Lazaroff, D.M.D
• Richard N Benjamin
• Valerie R Bolletino, LCSW
• David Derosa
• Randy W Dillon, MS,ATC,LAT, LMT, PES
• Divine Providence Village
• Stephen P Donahue, M.A.
• Margaret M Donnelly, PTA

• Durable Medical Equipment & Medical Supplies in Prospect Park, PA
• Providers in Prospect Park, PA by specialty
• Durable Medical Equipment & Medical Supplies in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.