Healthcare Provider Details

I. General information

NPI: 1578608105
Provider Name (Legal Business Name): 255 COLUMBUS AVE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 COLUMBUS AVE
NEW YORK NY
10023-3330
US

IV. Provider business mailing address

255 COLUMBUS AVE
NEW YORK NY
10023-3330
US

V. Phone/Fax

Practice location:
  • Phone: 212-362-9170
  • Fax: 212-362-9478
Mailing address:
  • Phone: 212-362-9170
  • Fax: 212-362-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number015922
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ESSOH CLAUDE ESSIMEL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 212-362-9170