Provider Demographics
NPI:1497820112
Name:ROBERT BONSIGNORE & IRA WIENER PARTNERS
Entity Type:Organization
Organization Name:ROBERT BONSIGNORE & IRA WIENER PARTNERS
Other - Org Name:PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-256-8423
Mailing Address - Street 1:1678 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-256-8413
Mailing Address - Fax:718-256-2154
Practice Address - Street 1:1678 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:718-256-8413
Practice Address - Fax:718-256-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15454333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3303221OtherNABP
NY00263570Medicaid
NY0133170001Medicare NSC