Provider Demographics
NPI:1477925576
Name:MEDICAL TECHNOLOGY PHARMACY
Entity type:Organization
Organization Name:MEDICAL TECHNOLOGY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTICO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-602-4512
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-0134
Mailing Address - Country:US
Mailing Address - Phone:201-881-8281
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1630
Practice Address - Country:US
Practice Address - Phone:201-881-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00744800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy