Healthcare Provider Details

I. General information

NPI: 1609897677
Provider Name (Legal Business Name): HAMTINI CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SENECA AVE
RIDGEWOOD NY
11385-2170
US

IV. Provider business mailing address

615 SENECA AVE
RIDGEWOOD NY
11385-2170
US

V. Phone/Fax

Practice location:
  • Phone: 718-326-3673
  • Fax: 718-326-3675
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number027221
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMIR HAMTINI
Title or Position: MANAGER
Credential:
Phone: 718-326-3673