Provider Demographics
NPI:1689804346
Name:PRINCETON ADVANCED TECHNOLOGIES LLC
Entity Type:Organization
Organization Name:PRINCETON ADVANCED TECHNOLOGIES LLC
Other - Org Name:SCHODACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRANCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-512-5181
Mailing Address - Street 1:81 MILLER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-4035
Mailing Address - Country:US
Mailing Address - Phone:518-512-5181
Mailing Address - Fax:518-512-5184
Practice Address - Street 1:81 MILLER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-4035
Practice Address - Country:US
Practice Address - Phone:518-512-5181
Practice Address - Fax:518-512-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029581333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3361829OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6301100001Medicare NSC