Provider Demographics
NPI:1407963994
Name:K. DIAMOND PHARMACY. INC
Entity Type:Organization
Organization Name:K. DIAMOND PHARMACY. INC
Other - Org Name:DERMER SURGICAL SUPPLIES & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAPOLITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-377-4900
Mailing Address - Street 1:2064 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4314
Mailing Address - Country:US
Mailing Address - Phone:718-377-4900
Mailing Address - Fax:718-252-6050
Practice Address - Street 1:2064 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4314
Practice Address - Country:US
Practice Address - Phone:718-377-4900
Practice Address - Fax:718-252-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020075332B00000X, 333600000X, 3336C0003X, 332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01102652Medicaid
2065595OtherPK
0531420001Medicare NSC
NY0531420001Medicare ID - Type UnspecifiedMEDICARE NUMBER
NY3393612OtherNCPDP NUMBER