Provider Demographics
NPI:1295722007
Name:JP PHOTO AND BEAUTY SUPPLIES CORP.
Entity type:Organization
Organization Name:JP PHOTO AND BEAUTY SUPPLIES CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-538-8100
Mailing Address - Street 1:72 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8203
Mailing Address - Country:US
Mailing Address - Phone:718-538-8100
Mailing Address - Fax:718-538-8118
Practice Address - Street 1:72 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8203
Practice Address - Country:US
Practice Address - Phone:718-538-8100
Practice Address - Fax:718-538-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027314332B00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02707495Medicaid
NY3346613OtherNABP
NY5524630001Medicare NSC