Provider Demographics
NPI:1487023016
Name:JADZ INC
Entity Type:Organization
Organization Name:JADZ INC
Other - Org Name:MEDI SERV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAKHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-272-3381
Mailing Address - Street 1:2611 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4845
Mailing Address - Country:US
Mailing Address - Phone:718-395-4000
Mailing Address - Fax:
Practice Address - Street 1:2611 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4845
Practice Address - Country:US
Practice Address - Phone:718-395-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7553150001Medicare NSC