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General NPI Number Information
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NPI Number | 1376568923
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Entity Type | Organization
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Legal Business Name | WALDBAUM INC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 13311 20TH AVE
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City | COLLEGE POINT
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State | NY
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Zip | 11356-2405
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Country | US
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Telephone | 718-460-8259
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Fax | 718-359-4059
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Provider Business Mailing Address
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Address Line | 13311 20TH AVE
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City | COLLEGE POINT
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State | NY
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Zip | 11356-2405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY SPECIALIST
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Name | SUSAN KIJOWSKI
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Credential |
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Telephone | 201-571-8326
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 022011
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 022011
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License Number State | NY
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