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General NPI Number Information
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NPI Number | 1013336700
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Entity Type | Organization
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Legal Business Name | NEWMOONPHARMACY INC
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 109-14 LIBERTY AVENUE 109-14 LIBRERTY AVENUE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-738-0302
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Fax | 718-738-0303
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Provider Business Mailing Address
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Address Line | 10914 LIBERTY AVE 109-14 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1704
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Country | US
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Telephone | 718-738-0302
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Fax | 718-738-0303
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Authorized Official
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Title or Position | PRESIDENT
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Name | HARRIS HUSSNAIN
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Credential | MASTER
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Telephone | 718-738-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 17032657
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License Number State | NY
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