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General NPI Number Information
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NPI Number | 1093737967
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Entity Type | Organization
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Legal Business Name | CONEY ISLAND HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 3514 MERMAID AVE
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City | BROOKLYN
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State | NY
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Zip | 11224-1508
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Country | US
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Telephone | 718-265-9108
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Fax | 718-265-5327
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Provider Business Mailing Address
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Address Line | 3514 MERMAID AVE
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City | BROOKLYN
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State | NY
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Zip | 11224-1508
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Country | US
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Telephone | 718-265-9108
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Fax | 718-265-5327
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PERVEZ A. SIDDIQUI
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Credential | RPH
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Telephone | 718-265-9108
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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 | 022534
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License Number State | NY
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