Provider Demographics
NPI:1417004581
Name:NEW NEIGHBORHOOD PHARMACY
Entity Type:Organization
Organization Name:NEW NEIGHBORHOOD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-361-6060
Mailing Address - Street 1:4512 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2410
Mailing Address - Country:US
Mailing Address - Phone:718-361-6060
Mailing Address - Fax:718-361-3119
Practice Address - Street 1:4512 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2410
Practice Address - Country:US
Practice Address - Phone:718-361-6060
Practice Address - Fax:718-361-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02721355Medicaid
NY3343059Medicare ID - Type UnspecifiedNABP