=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215201090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNAPP NUTRITIONAL & PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2012
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9525 CHURCH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11212-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-513-6178
-----------------------------------------------------
Fax | 718-513-6179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2310 KNAPP ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-513-6178
-----------------------------------------------------
Fax | 718-513-6179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DANIL SHABATAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-513-6178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 031235
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------