MEDICARE: 2244 FIRST AVE LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1396614384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2244 FIRST AVE LLC

Provider Business Mailing Address
First Line	:	2244 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-1614
Country	:	US
Telephone Number	:	718-640-5775
Fax Number	:	516-963-0184

Provider Business Practice Location Address
First Line	:	2244 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-1614
Country	:	US
Telephone Number	:	718-640-5775
Fax Number	:	516-963-0184

Authorized Official
Title or Position	:	OWNER
Name	:	IGOR SHAMALOV
Credential	:
Telephone Number	:	718-640-5775

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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