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NPI Code Detail

MEDICARE: WALDBAUM INC

MEDICARE: WALDBAUM INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies023768NY
3333600000XPharmacy023768NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23344265OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1093730640
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALDBAUM INC
Provider Business Mailing Address
First Line : 1441 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-1553
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1441 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-1553
Country : US
Telephone Number : 718-698-2632
Fax Number : 718-698-1945
Authorized Official
Title or Position : PHARMACY SPECIALIST
Name : SUSAN KIJOWSKI
Credential :
Telephone Number : 201-571-8326
Provider Enumeration Date : 07/13/2006
Last Update Date : 11/09/2007

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