Provider Demographics
NPI:1013344936
Name:INDAAZ INC.
Entity Type:Organization
Organization Name:INDAAZ INC.
Other - Org Name:ESTATES PHARMACY & SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER / PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-739-0311
Mailing Address - Street 1:16901 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4434
Mailing Address - Country:US
Mailing Address - Phone:718-739-0311
Mailing Address - Fax:718-739-0999
Practice Address - Street 1:16901 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4434
Practice Address - Country:US
Practice Address - Phone:718-739-0311
Practice Address - Fax:718-739-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0322703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03793919Medicaid
NY7028550001Medicare NSC