Provider Demographics
NPI:1679092563
Name:SKG OF NEW YORK INC.
Entity Type:Organization
Organization Name:SKG OF NEW YORK INC.
Other - Org Name:HEAVEN AID PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-668-3057
Mailing Address - Street 1:106 BODEN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-668-3057
Mailing Address - Fax:
Practice Address - Street 1:2385 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6807
Practice Address - Country:US
Practice Address - Phone:347-879-7870
Practice Address - Fax:347-879-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183500000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty