Provider Demographics
NPI:1710091442
Name:LONGWOOD DRUG & SURGICAL INC
Entity Type:Organization
Organization Name:LONGWOOD DRUG & SURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TATARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-542-4770
Mailing Address - Street 1:839B PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3912
Mailing Address - Country:US
Mailing Address - Phone:718-542-4770
Mailing Address - Fax:718-991-8564
Practice Address - Street 1:839-B PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3912
Practice Address - Country:US
Practice Address - Phone:718-542-4770
Practice Address - Fax:718-991-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00901937Medicaid
NY00901937Medicaid