Provider Demographics
NPI:1932254364
Name:COTTAGE PHARMACY & SURGICAL, INC
Entity Type:Organization
Organization Name:COTTAGE PHARMACY & SURGICAL, INC
Other - Org Name:COTTAGE SURGICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDRAPRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VENIGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-367-9030
Mailing Address - Street 1:8285 JERICHO TPKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1807
Mailing Address - Country:US
Mailing Address - Phone:516-367-9030
Mailing Address - Fax:516-367-3875
Practice Address - Street 1:8285 JERICHO TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1807
Practice Address - Country:US
Practice Address - Phone:516-367-9030
Practice Address - Fax:516-367-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4506760001Medicare ID - Type UnspecifiedMEDICARE