Healthcare Provider Details

I. General information

NPI: 1376636704
Provider Name (Legal Business Name): STEPHEN J. KATSIFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 ASBURY AVE
OCEAN CITY NJ
08226-3612
US

IV. Provider business mailing address

862 ASBURY AVE
OCEAN CITY NJ
08226-3612
US

V. Phone/Fax

Practice location:
  • Phone: 609-399-3535
  • Fax: 609-399-7254
Mailing address:
  • Phone: 609-399-3535
  • Fax: 609-399-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00094400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN KATSIFF
Title or Position: OWNER
Credential: R.PH.
Phone: 609-399-3535