Provider Demographics
NPI:1093760506
Name:ESSEX STREET CORP
Entity Type:Organization
Organization Name:ESSEX STREET CORP
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUBASHRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-342-7368
Mailing Address - Street 1:440 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5636
Mailing Address - Country:US
Mailing Address - Phone:718-342-7368
Mailing Address - Fax:
Practice Address - Street 1:440 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5636
Practice Address - Country:US
Practice Address - Phone:718-342-7368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022185332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3393078OtherNCPDP
NY01487145Medicaid
NY0956520001Medicare NSC