Healthcare Provider Details

I. General information

NPI: 1760729172
Provider Name (Legal Business Name): 2000 NINOS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 BROADWAY
NEW YORK NY
10031-1502
US

IV. Provider business mailing address

3663 BROADWAY
NEW YORK NY
10031-1502
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-2910
  • Fax: 212-491-9996
Mailing address:
  • Phone: 212-491-2910
  • Fax: 212-491-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number031805
License Number StateNY

VIII. Authorized Official

Name: KEYUR PATEL
Title or Position: MANAGER
Credential:
Phone: 212-491-2910