Provider Demographics
NPI:1740226109
Name:KINGS DRUG & SURGICAL CORP
Entity Type:Organization
Organization Name:KINGS DRUG & SURGICAL CORP
Other - Org Name:KINGS PHARMACY AND SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL GAUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-921-5656
Mailing Address - Street 1:492 CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2013
Mailing Address - Country:US
Mailing Address - Phone:718-363-3300
Mailing Address - Fax:718-363-2949
Practice Address - Street 1:492 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2013
Practice Address - Country:US
Practice Address - Phone:718-363-3300
Practice Address - Fax:718-363-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0231203336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01691607Medicaid
2062556OtherPK
NY01691607Medicaid