Provider Demographics
NPI:1265455257
Name:SISTERS OF ST. JOSEPH
Entity Type:Organization
Organization Name:SISTERS OF ST. JOSEPH
Other - Org Name:MARIA REGINA CONVENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TWOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-299-3029
Mailing Address - Street 1:1725 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5543
Practice Address - Country:US
Practice Address - Phone:631-299-3029
Practice Address - Fax:631-952-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013318333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3320619OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY01668184Medicaid