Healthcare Provider Details

I. General information

NPI: 1376355743
Provider Name (Legal Business Name): ESCRIPT360 LONG ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 FRANKLIN AVE
GARDEN CITY NY
11530-4525
US

IV. Provider business mailing address

728 FRANKLIN AVE
GARDEN CITY NY
11530-4525
US

V. Phone/Fax

Practice location:
  • Phone: 516-696-3370
  • Fax: 516-696-3371
Mailing address:
  • Phone: 516-696-3370
  • Fax: 516-696-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YURIY DAVYDOV
Title or Position: OWNER
Credential:
Phone: 646-633-2170