Provider Demographics
NPI: | 1457769630 |
---|---|
Name: | CENTRAL ATA, INC. |
Entity Type: | Organization |
Organization Name: | CENTRAL ATA, INC. |
Other - Org Name: | CENTRAL AVE PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | AMROU |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | ELDSOKY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 718-942-5855 |
Mailing Address - Street 1: | 334B CENTRAL AVENUE |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11221 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-942-5855 |
Mailing Address - Fax: | 718-942-5859 |
Practice Address - Street 1: | 334B CENTRAL AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11221 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-942-5855 |
Practice Address - Fax: | 718-942-5859 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-07-31 |
Last Update Date: | 2015-06-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 7317850001 | Medicare NSC |