Provider Demographics
NPI:1164986782
Name:MAPLE RX NY LLC
Entity Type:Organization
Organization Name:MAPLE RX NY LLC
Other - Org Name:MAPLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:WERZBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-368-2273
Mailing Address - Street 1:382 ROUTE 59 STE 276
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3422
Mailing Address - Country:US
Mailing Address - Phone:845-368-2273
Mailing Address - Fax:
Practice Address - Street 1:59 ROUTE 59 STE 143
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3543
Practice Address - Country:US
Practice Address - Phone:845-371-6464
Practice Address - Fax:845-371-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy