Provider Demographics
NPI:1013257286
Name:NY88 LLC
Entity type:Organization
Organization Name:NY88 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIN
Authorized Official - Middle Name:FOOK
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-799-0999
Mailing Address - Street 1:5737 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5332
Mailing Address - Country:US
Mailing Address - Phone:718-799-0999
Mailing Address - Fax:718-539-1919
Practice Address - Street 1:5737 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5332
Practice Address - Country:US
Practice Address - Phone:718-799-0999
Practice Address - Fax:718-539-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170316953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031695Medicaid
NY5806902OtherNCPDP
NY031695Medicaid