Provider Demographics
NPI:1447589361
Name:TOWN TOTAL BAYSIDE, LLC
Entity Type:Organization
Organization Name:TOWN TOTAL BAYSIDE, LLC
Other - Org Name:TOWN TOTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-213-5570
Mailing Address - Street 1:2619 FRANCIS LEWIS BLVD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1145
Mailing Address - Country:US
Mailing Address - Phone:718-971-1344
Mailing Address - Fax:718-971-1349
Practice Address - Street 1:2619 FRANCIS LEWIS BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1145
Practice Address - Country:US
Practice Address - Phone:718-971-1344
Practice Address - Fax:718-971-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029923333600000X, 3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy