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General NPI Number Information
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NPI Number | 1962721688
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Entity Type | Organization
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Legal Business Name | NATES SPECIALTY PHARMACY CORP
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 2304 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11210-3840
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Country | US
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Telephone | 718-338-0709
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Fax | 718-338-3880
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Provider Business Mailing Address
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Address Line | 516 BROADWAY
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2804
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Country | US
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Telephone | 718-720-3710
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Fax | 718-360-9650
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Authorized Official
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Title or Position | PRESIDENT
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Name | BORIS NATENZON
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Credential |
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Telephone | 917-734-4662
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 030093
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License Number State | NY
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