Provider Demographics
NPI:1073724282
Name:HINDERSTEIN, GREGG F (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:F
Last Name:HINDERSTEIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PEPPERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-2111
Mailing Address - Country:US
Mailing Address - Phone:718-833-4810
Mailing Address - Fax:718-833-4572
Practice Address - Street 1:8016 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3002
Practice Address - Country:US
Practice Address - Phone:718-833-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044487OtherPHARMACY LICENSE