Provider Demographics
NPI:1760497374
Name:LINDENVIEW RAINDEW CORP
Entity Type:Organization
Organization Name:LINDENVIEW RAINDEW CORP
Other - Org Name:RAINDEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SP
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-762-8041
Mailing Address - Street 1:25 39 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1296
Mailing Address - Country:US
Mailing Address - Phone:718-762-8041
Mailing Address - Fax:718-762-8130
Practice Address - Street 1:25 39 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1296
Practice Address - Country:US
Practice Address - Phone:718-762-8041
Practice Address - Fax:718-762-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0214843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01424368Medicaid
3326382OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0974480001Medicare NSC