Healthcare Provider Details

I. General information

NPI: 1548487648
Provider Name (Legal Business Name): J W EMBASSY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 145TH ST
NEW YORK NY
10039-4121
US

IV. Provider business mailing address

200 W 145TH ST
NEW YORK NY
10039-4121
US

V. Phone/Fax

Practice location:
  • Phone: 212-368-8100
  • Fax: 212-234-1512
Mailing address:
  • Phone: 212-368-8100
  • Fax: 212-234-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number016953
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SYED ALAM
Title or Position: RPH
Credential:
Phone: 212-368-8100