Provider Demographics
NPI:1033323522
Name:1875 LEXINGTON AVENUE LLC OF NYS
Entity Type:Organization
Organization Name:1875 LEXINGTON AVENUE LLC OF NYS
Other - Org Name:QUICK RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LORINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-830-2522
Mailing Address - Street 1:1047 SURF AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2810
Mailing Address - Country:US
Mailing Address - Phone:212-249-8202
Mailing Address - Fax:917-722-0851
Practice Address - Street 1:279 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1624
Practice Address - Country:US
Practice Address - Phone:845-295-3335
Practice Address - Fax:917-722-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NY0283683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2069356OtherPK
NY2889114Medicaid
NY038230OtherPHARMACY LICENSE