Provider Demographics
NPI:1881714145
Name:KIRSHNER, JAY (RPH)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:KIRSHNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2512
Mailing Address - Country:US
Mailing Address - Phone:516-633-3484
Mailing Address - Fax:516-670-8889
Practice Address - Street 1:639 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2512
Practice Address - Country:US
Practice Address - Phone:516-633-3484
Practice Address - Fax:516-670-8889
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042409OtherPHARMACY LICENSE NUMBER