=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609246503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED AND CRIPPLED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2015
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 E 70TH ST PHARMACY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-606-1371
-----------------------------------------------------
Fax | 212-628-4652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 E 70TH ST PHARMACY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-606-1371
-----------------------------------------------------
Fax | 212-628-4652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PHARMACY OFFICER
-----------------------------------------------------
Name | MRS. TINA YIP
-----------------------------------------------------
Credential | PHARM.D., RPH
-----------------------------------------------------
Telephone | 212-606-1371
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 003997
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------