Provider Demographics
NPI:1457366981
Name:CDC PLUS, INC
Entity Type:Organization
Organization Name:CDC PLUS, INC
Other - Org Name:BROADWAY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:BILAL
Authorized Official - Last Name:AKRAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:929-228-8822
Mailing Address - Street 1:57 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2503
Mailing Address - Country:US
Mailing Address - Phone:973-485-9150
Mailing Address - Fax:973-485-5462
Practice Address - Street 1:57 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2503
Practice Address - Country:US
Practice Address - Phone:973-485-9150
Practice Address - Fax:973-485-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3434800332B00000X
NJ28RS004407003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4415604Medicaid
NJ0588880001Medicare NSC