Provider Demographics
NPI:1578628871
Name:STAFF MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:STAFF MEDICAL SUPPLY INC
Other - Org Name:JACOFFS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:718-774-3311
Mailing Address - Street 1:PO BOX 250845
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3514
Mailing Address - Country:US
Mailing Address - Phone:718-774-3311
Mailing Address - Fax:718-467-0741
Practice Address - Street 1:327 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3514
Practice Address - Country:US
Practice Address - Phone:718-774-3311
Practice Address - Fax:718-467-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0088113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00261656Medicaid
NY00261656Medicaid