Provider Demographics
NPI:1356419915
Name:ROSE FAY PHARMACEUTICAL INC
Entity type:Organization
Organization Name:ROSE FAY PHARMACEUTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-745-5499
Mailing Address - Street 1:6216 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5204
Mailing Address - Country:US
Mailing Address - Phone:718-745-5499
Mailing Address - Fax:718-921-4661
Practice Address - Street 1:6216 11TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5204
Practice Address - Country:US
Practice Address - Phone:718-745-5499
Practice Address - Fax:718-921-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01148434Medicaid
NY3395678OtherNABP NUMBER
NY3395678OtherNABP NUMBER