Provider Demographics
NPI:1720155393
Name:HEALTHMAX CORPORATION
Entity Type:Organization
Organization Name:HEALTHMAX CORPORATION
Other - Org Name:HEALTHMAX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY,PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-296-0400
Mailing Address - Street 1:8007 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1902
Mailing Address - Country:US
Mailing Address - Phone:718-296-0400
Mailing Address - Fax:718-296-2815
Practice Address - Street 1:8007 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1902
Practice Address - Country:US
Practice Address - Phone:718-296-0400
Practice Address - Fax:718-296-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02238035Medicaid
NY3324061OtherNCPDP
NY3324061OtherNCPDP