Healthcare Provider Details

I. General information

NPI: 1134435076
Provider Name (Legal Business Name): 1163 NOSTRAND CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 101ST AVE
OZONE PARK NY
11416-2017
US

IV. Provider business mailing address

8401 101ST AVE
OZONE PARK NY
11416-2017
US

V. Phone/Fax

Practice location:
  • Phone: 718-934-8888
  • Fax:
Mailing address:
  • Phone: 718-934-8888
  • Fax:

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: ELAN KATZ
Title or Position: PRESIDENT
Credential:
Phone: 718-934-8888