MEDICARE: NEW STAGE PHARMACY 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
1	183500000X	Pharmacist	10520	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

General Provider Information

NPI Number	:	1912184193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW STAGE PHARMACY INC

Provider Business Mailing Address
First Line	:	20419 HILLSIDE AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2213
Country	:	US
Telephone Number	:	516-658-6854
Fax Number	:

Provider Business Practice Location Address
First Line	:	20419 HILLSIDE AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2213
Country	:	US
Telephone Number	:	516-658-6854
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KHOSROW G MOGHADDAM
Credential	:
Telephone Number	:	718-465-2121

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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