Healthcare Provider Details

I. General information

NPI: 1255446282
Provider Name (Legal Business Name): NYC AND EZY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HOWARD AVE
MAPLE PLAIN MN
55359-9634
US

IV. Provider business mailing address

1500 HOWARD AVE
MAPLE PLAIN MN
55359-9634
US

V. Phone/Fax

Practice location:
  • Phone: 763-479-1903
  • Fax: 763-479-6516
Mailing address:
  • Phone: 763-479-1903
  • Fax: 763-479-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number200719
License Number StateMN

VIII. Authorized Official

Name: JOSEPH REYCRAFT
Title or Position: PRESIDENT
Credential: RPH
Phone: 763-479-1903