Healthcare Provider Details

I. General information

NPI: 1467637512
Provider Name (Legal Business Name): MAGDY MASSAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CASTLE HILL AVE
BRONX NY
10473-1402
US

IV. Provider business mailing address

650 CASTLE HILL AVE
BRONX NY
10473-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-6304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: