Healthcare Provider Details

I. General information

NPI: 1407150568
Provider Name (Legal Business Name): NILVARNI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 KINDERKAMACK RD SUITE 104
ORADELL NJ
07649
US

IV. Provider business mailing address

680 KINDERKAMACK RD SUITE 104
ORADELL NJ
07649
US

V. Phone/Fax

Practice location:
  • Phone: 201-477-0222
  • Fax:
Mailing address:
  • Phone: 201-477-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00711400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELSAYED ABDELHAMID
Title or Position: OWNER
Credential:
Phone: 201-888-7685