Provider Demographics
NPI:1033168950
Name:WILLIAMSBURG PHARMACY & SURGICAL SUPPLY INC
Entity Type:Organization
Organization Name:WILLIAMSBURG PHARMACY & SURGICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELLOCHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-387-9772
Mailing Address - Street 1:244 ROEBLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5664
Mailing Address - Country:US
Mailing Address - Phone:718-387-9772
Mailing Address - Fax:718-387-8291
Practice Address - Street 1:244 ROEBLING ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5664
Practice Address - Country:US
Practice Address - Phone:718-387-9772
Practice Address - Fax:718-387-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01158534Medicaid
NY01158534Medicaid