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General NPI Number Information
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NPI Number | 1033323522
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Entity Type | Organization
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Legal Business Name | 1875 LEXINGTON AVENUE LLC OF NYS
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 279 MAIN ST STE 103
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City | NEW PALTZ
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State | NY
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Zip | 12561-1624
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Country | US
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Telephone | 845-295-3335
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Fax | 917-722-0851
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Provider Business Mailing Address
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Address Line | 1047 SURF AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11224-2810
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Country | US
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Telephone | 212-249-8202
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Fax | 917-722-0851
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Authorized Official
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Title or Position | PIC
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Name | BERNARD LORINO
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Credential |
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Telephone | 917-830-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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