MEDICARE: NYC AND EZY CORP

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	200719	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2406127	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255446282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC AND EZY CORP

Provider Business Mailing Address
First Line	:	1500 HOWARD AVE
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9634
Country	:	US
Telephone Number	:	763-479-1903
Fax Number	:	763-479-6516

Provider Business Practice Location Address
First Line	:	1500 HOWARD AVE
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9634
Country	:	US
Telephone Number	:	763-479-1903
Fax Number	:	763-479-6516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH REYCRAFT
Credential	:	RPH
Telephone Number	:	763-479-1903

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	04/01/2011

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Directions to “NYC AND EZY CORP ” Practice Location

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