Provider Demographics
NPI:1578088647
Name:CHELSEA CARE RX CORP
Entity Type:Organization
Organization Name:CHELSEA CARE RX CORP
Other - Org Name:CHELSEA MOBILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNATANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-255-5522
Mailing Address - Street 1:327 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4807
Mailing Address - Country:US
Mailing Address - Phone:212-255-5522
Mailing Address - Fax:212-255-4686
Practice Address - Street 1:327 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4807
Practice Address - Country:US
Practice Address - Phone:212-255-5522
Practice Address - Fax:212-255-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0357823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173091OtherPK
NY=========OtherIRS