Provider Demographics
NPI:1205904596
Name:NY FIRST AVE CORPORATION
Entity type:Organization
Organization Name:NY FIRST AVE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-253-8686
Mailing Address - Street 1:206 1ST AVE
Mailing Address - Street 2:STORE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3720
Mailing Address - Country:US
Mailing Address - Phone:212-253-8686
Mailing Address - Fax:212-253-2415
Practice Address - Street 1:206 1ST AVE
Practice Address - Street 2:STORE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3720
Practice Address - Country:US
Practice Address - Phone:212-253-8686
Practice Address - Fax:212-253-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0245313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02108354Medicaid
NY3319983OtherNCDP
NY02108354Medicaid