Provider Demographics
NPI:1164443628
Name:SUPERIOR BIOLOGICS NY INC
Entity Type:Organization
Organization Name:SUPERIOR BIOLOGICS NY INC
Other - Org Name:SUPERIOR BIOLOGICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, TREASURER, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-494-3121
Mailing Address - Street 1:50 BROADWAY, STE OFF06
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1523
Mailing Address - Country:US
Mailing Address - Phone:914-747-1150
Mailing Address - Fax:914-747-1170
Practice Address - Street 1:50 BROADWAY, STE OFF06
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1523
Practice Address - Country:US
Practice Address - Phone:914-747-1150
Practice Address - Fax:914-747-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X, 3336M0002X, 3336S0011X, 3336H0001X
NY0313603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136122OtherPK
NY04203292Medicaid
2136122OtherPK