Healthcare Provider Details

I. General information

NPI: 1679092563
Provider Name (Legal Business Name): SKG OF NEW YORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 GRAND CONCOURSE
BRONX NY
10468-6807
US

IV. Provider business mailing address

106 BODEN AVE
VALLEY STREAM NY
11580
US

V. Phone/Fax

Practice location:
  • Phone: 347-879-7870
  • Fax: 347-879-7871
Mailing address:
  • Phone: 516-668-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNY

VIII. Authorized Official

Name: STEPHEN M MENSAH
Title or Position: PRESIDENT
Credential: RPH
Phone: 516-668-3057