Provider Demographics
NPI:1881147924
Name:EMBLEMHEALTH SERVICES COMPANY
Entity type:Organization
Organization Name:EMBLEMHEALTH SERVICES COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CORPORATE PHARMACY PROGRA
Authorized Official - Prefix:
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-447-1204
Mailing Address - Street 1:PO BOX 5228
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5228
Mailing Address - Country:US
Mailing Address - Phone:646-680-1180
Mailing Address - Fax:212-406-2015
Practice Address - Street 1:52 DUANE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1207
Practice Address - Country:US
Practice Address - Phone:646-680-1180
Practice Address - Fax:212-406-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0344253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162232OtherPK
NYN/AMedicaid