Provider Demographics
NPI:1568682227
Name:3 W 137 PHARMACY & MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:3 W 137 PHARMACY & MEDICAL SUPPLY, INC.
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VINBAYTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-939-0444
Mailing Address - Street 1:236 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4121
Mailing Address - Country:US
Mailing Address - Phone:917-939-0444
Mailing Address - Fax:212-260-4941
Practice Address - Street 1:3 W 137TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1900
Practice Address - Country:US
Practice Address - Phone:212-281-4881
Practice Address - Fax:212-281-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5930260001Medicare NSC