MEDICARE: HEALTH BRIDGE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	027073	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2063165	OTHER		PK

General Provider Information

NPI Number	:	1356327530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH BRIDGE INC

Provider Business Mailing Address
First Line	:	274 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7411
Country	:	US
Telephone Number	:	718-648-0002
Fax Number	:	718-648-0700

Provider Business Practice Location Address
First Line	:	274 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7411
Country	:	US
Telephone Number	:	718-648-0002
Fax Number	:	718-648-0700

Authorized Official
Title or Position	:	OWNER
Name	:	MARIANA YUSUPOVA
Credential	:	PHRMD
Telephone Number	:	718-648-0002

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	11/19/2013

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Directions to “HEALTH BRIDGE INC ” Practice Location

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