Provider Demographics
NPI:1073695862
Name:BARLEN PHARMACY INC
Entity Type:Organization
Organization Name:BARLEN PHARMACY INC
Other - Org Name:VILLAGE PHARMACY OF SYOSSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES PHCST
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-921-0880
Mailing Address - Street 1:38 COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3132
Mailing Address - Country:US
Mailing Address - Phone:516-921-0880
Mailing Address - Fax:516-921-7975
Practice Address - Street 1:38 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3132
Practice Address - Country:US
Practice Address - Phone:516-921-0880
Practice Address - Fax:516-921-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0263863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02529220Medicaid
2061585OtherPK
2061585OtherPK