Provider Demographics
NPI:1851807929
Name:LONG ISLAND JEWISH MEDICAL CENTER AT HOME PHARMACY INC
Entity Type:Organization
Organization Name:LONG ISLAND JEWISH MEDICAL CENTER AT HOME PHARMACY INC
Other - Org Name:VIVO HEALTH PHARMACY AT HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP, CHEIEF EXPENSE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-868-8486
Mailing Address - Street 1:1983 MARCUS AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:833-868-8486
Mailing Address - Fax:516-266-5332
Practice Address - Street 1:225 COMMUNITY DR STE 140
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5506
Practice Address - Country:US
Practice Address - Phone:833-868-8486
Practice Address - Fax:516-266-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0357803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175155OtherPK