Healthcare Provider Details

I. General information

NPI: 1528161072
Provider Name (Legal Business Name): EMPIRE PHARMACY & SURGICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50-17 QUEENS BLVD
WOODSIDE NY
11377-4452
US

IV. Provider business mailing address

50-17 QUEENS BLVD
WOODSIDE NY
11377-4452
US

V. Phone/Fax

Practice location:
  • Phone: 718-205-1275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0986785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022856
License Number StateNY

VIII. Authorized Official

Name: MARK CHRISTOPHER MARTELL
Title or Position: PRESIDENT/SUPERVISING PHARMACIST
Credential:
Phone: 718-205-1275