Provider Demographics
NPI:1700025665
Name:MEDWIZ SPECIALTY, LLC
Entity Type:Organization
Organization Name:MEDWIZ SPECIALTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-624-5200
Mailing Address - Street 1:167 ROUTE 304
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2050
Mailing Address - Country:US
Mailing Address - Phone:845-624-5200
Mailing Address - Fax:845-624-5300
Practice Address - Street 1:167 ROUTE 304
Practice Address - Street 2:SUITE 201
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2050
Practice Address - Country:US
Practice Address - Phone:845-624-5200
Practice Address - Fax:845-624-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6213690001Medicare NSC