Provider Demographics
NPI:1063640811
Name:MIDTOWN EAST PHARMACY & SURGICAL LLC
Entity Type:Organization
Organization Name:MIDTOWN EAST PHARMACY & SURGICAL LLC
Other - Org Name:MIDTOWN EAST PHARMACY & SURGICAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-213-2444
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-213-2444
Mailing Address - Fax:212-213-2877
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-213-2444
Practice Address - Fax:212-213-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029513333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3334154Medicaid
2120890OtherPK