Healthcare Provider Details

I. General information

NPI: 1679628747
Provider Name (Legal Business Name): 2355 2ND AVE NYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 2ND AVE
NEW YORK NY
10035-3107
US

IV. Provider business mailing address

2355 2ND AVE
NEW YORK NY
10035-3107
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-7151
  • Fax: 646-290-6472
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUE ROTTURA
Title or Position: COO
Credential:
Phone: 561-323-8987