Provider Demographics
NPI:1932466067
Name:NYU HOSPITALS CENTER, CENTER FOR MUSKULOSKELETAL CARE PHARMA
Entity Type:Organization
Organization Name:NYU HOSPITALS CENTER, CENTER FOR MUSKULOSKELETAL CARE PHARMA
Other - Org Name:NYU CENTER FOR MUSKULOSKELETAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH./PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-628-6488
Mailing Address - Street 1:333 E 38TH ST
Mailing Address - Street 2:ROOM 4-303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2772
Mailing Address - Country:US
Mailing Address - Phone:646-501-7444
Mailing Address - Fax:
Practice Address - Street 1:333 E 38TH ST RM 4-303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2772
Practice Address - Country:US
Practice Address - Phone:646-501-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0311803336H0001X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5804845OtherNCPDP PROVIDER IDENTIFICATION NUMBER