Profile Shop, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

6000005802 Issued in PA

Legal business name

PROFILE SHOP, INC.

Practice address

45 Second Street Pike
Suite 300
Southampton, PA 18966-3806

Phone

(215) 355-5788

Fax

(215) 355-5778

NPI assigned

Aug 26, 2011

Organization subpart

Yes

Parent organization

PROFILE SHOP, INCAs reported in NPPES

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

Authorized official

Name

Diane L Gesualdi, CMF

Title

President

Phone

(215) 355-5788

Specialties & licenses 1

Addresses

Part of

Profile Shop Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Profile Shop, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Bensalem, PA
  • NPI 1205837291
  NPPES parent name

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

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348617600000",
    "number": "1982984530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 TILLMAN DR",
            "address_2": "SUITE 105",
            "city": "BENSALEM",
            "state": "PA",
            "postal_code": "190202071",
            "telephone_number": "215-633-3461",
            "fax_number": "215-633-3567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 SECOND STREET PIKE",
            "address_2": "SUITE 300",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189663806",
            "telephone_number": "215-355-5788",
            "fax_number": "215-355-5778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFILE SHOP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFILE SHOP, INC",
        "enumeration_date": "2011-08-26",
        "last_updated": "2012-09-26",
        "status": "A",
        "authorized_official_last_name": "GESUALDI",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-355-5788",
        "authorized_official_credential": "CMF"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "6000005802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Orthopaedic and Sports Medicine Associates, LTD
• Premium Eye Surgeons Inc
• Premium Health, P.C.
• Jessica Prince Wolfish, MD
• Richard B Prince, M.D.
• Progress PT Centers for Fitness & Rehabilitation
• Progress PT Centers for Fitness and Rehabilitation LLC
• Promont Recovery LLC
• Louis Robert Prusack, DDS
• Samuel Paul Purpura Jr., DO

• Durable Medical Equipment & Medical Supplies in Southampton, PA
• Providers in Southampton, 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 Sep 26, 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.