Provider Demographics
NPI:1548587173
Name:EQUAL CARE III LLC
Entity Type:Organization
Organization Name:EQUAL CARE III LLC
Other - Org Name:EQUAL CARE III LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-888-9338
Mailing Address - Street 1:4059 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5140
Mailing Address - Country:US
Mailing Address - Phone:718-888-9338
Mailing Address - Fax:718-888-9299
Practice Address - Street 1:4059 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5140
Practice Address - Country:US
Practice Address - Phone:718-888-9338
Practice Address - Fax:718-888-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0301653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03245741Medicaid
2125459OtherPK
6449410001Medicare NSC