Healthcare Provider Details

I. General information

NPI: 1235144866
Provider Name (Legal Business Name): PNY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E CENTRAL AVE RT 59
SPRING VALLEY NY
10977
US

IV. Provider business mailing address

180 E CENTRAL AVE
SPRING VALLEY NY
10977
US

V. Phone/Fax

Practice location:
  • Phone: 845-352-0490
  • Fax: 845-352-0524
Mailing address:
  • Phone: 845-352-0490
  • Fax: 845-352-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number023761
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01878748
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier3395882
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: DIPAK RAO
Title or Position: PRESIDENT
Credential: BS
Phone: 845-352-0490