MEDICARE: JP PHOTO AND BEAUTY SUPPLIES 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	027314	NY
2	183500000X	Pharmacist	027314	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3346613	OTHER	NY	NABP

General Provider Information

NPI Number	:	1295722007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JP PHOTO AND BEAUTY SUPPLIES CORP.

Provider Business Mailing Address
First Line	:	72 E 167TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8203
Country	:	US
Telephone Number	:	718-538-8100
Fax Number	:	718-538-8118

Provider Business Practice Location Address
First Line	:	72 E 167TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8203
Country	:	US
Telephone Number	:	718-538-8100
Fax Number	:	718-538-8118

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT LEE
Credential	:
Telephone Number	:	718-538-8100

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/31/2007

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Directions to “JP PHOTO AND BEAUTY SUPPLIES CORP. ” Practice Location

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