Provider Demographics
NPI:1528385184
Name:CROSS BAY CHEMIST OF OZONE PARK CORP.
Entity Type:Organization
Organization Name:CROSS BAY CHEMIST OF OZONE PARK CORP.
Other - Org Name:CROSS BAY CHEMIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-880-1644
Mailing Address - Street 1:9605 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2521
Mailing Address - Country:US
Mailing Address - Phone:718-880-1644
Mailing Address - Fax:718-880-1606
Practice Address - Street 1:9605 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2521
Practice Address - Country:US
Practice Address - Phone:718-880-1644
Practice Address - Fax:718-880-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6456530001Medicare NSC