Provider Demographics
NPI:1396827309
Name:BELLE HARBOR CHEMISTS INC
Entity Type:Organization
Organization Name:BELLE HARBOR CHEMISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-634-0001
Mailing Address - Street 1:412 BEACH 129 ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-634-0001
Mailing Address - Fax:718-634-5472
Practice Address - Street 1:412 BEACH 129 ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:718-634-0001
Practice Address - Fax:718-634-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753337Medicaid
NY4893540001Medicare NSC