Healthcare Provider Details

I. General information

NPI: 1639885460
Provider Name (Legal Business Name): ESCRIPT360 NYC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 1ST AVE
NEW YORK NY
10021-5503
US

IV. Provider business mailing address

5 PENNY POND CT
GREENVALE NY
11548-1400
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-1700
  • Fax: 212-535-1722
Mailing address:
  • Phone: 646-633-2170
  • Fax: 516-492-3356

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: MEMBER
Credential:
Phone: 646-633-2170