Provider Demographics
NPI:1962969840
Name:EDWIN JOHN SZCZEPANIK
Entity type:Organization
Organization Name:EDWIN JOHN SZCZEPANIK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-352-6888
Mailing Address - Street 1:7758 WALLACE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7217
Mailing Address - Country:US
Mailing Address - Phone:407-352-6888
Mailing Address - Fax:407-352-0560
Practice Address - Street 1:7758 WALLACE RD STE 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7217
Practice Address - Country:US
Practice Address - Phone:407-352-6888
Practice Address - Fax:407-352-0560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWIN JOHN SZCZEPANIK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies