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NPI Code Detail

MEDICARE: WALDBAUM INC

MEDICARE: WALDBAUM 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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies021087NY
3333600000XPharmacy021087NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13399537OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629093273
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALDBAUM INC
Provider Business Mailing Address
First Line : 2149 RALPH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-5405
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2149 RALPH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-5405
Country : US
Telephone Number : 718-531-7682
Fax Number : 718-531-3852
Authorized Official
Title or Position : PHARMACY SPECIALIST
Name : SUSAN KIJOWSKI
Credential :
Telephone Number : 201-571-8326
Provider Enumeration Date : 07/13/2006
Last Update Date : 11/09/2007

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Directions to “WALDBAUM INC ” Practice Location

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