Provider Demographics
NPI:1609929686
Name:ABHINAV CORP
Entity Type:Organization
Organization Name:ABHINAV CORP
Other - Org Name:NEW LOTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NARENDAR
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:BOKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-238-2279
Mailing Address - Street 1:739 NEW LOTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-7305
Mailing Address - Country:US
Mailing Address - Phone:718-649-9535
Mailing Address - Fax:718-649-3456
Practice Address - Street 1:739 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-7305
Practice Address - Country:US
Practice Address - Phone:718-649-9535
Practice Address - Fax:718-649-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02081276Medicaid
NY3981330001Medicare NSC