1639349442 NPI number — LEZRX INC

Table of content: (NPI 1639349442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639349442 NPI number — LEZRX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEZRX INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEZRX INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639349442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLENVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12428-0505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-626-1278
Provider Business Mailing Address Fax Number:
845-626-1177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4737 ROUTE 209
Provider Second Line Business Practice Location Address:
LOT 2
Provider Business Practice Location Address City Name:
ACCORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12404-5754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-626-1278
Provider Business Practice Location Address Fax Number:
845-626-1177
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DESARME
Authorized Official First Name:
LESLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-626-1278

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  028821 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02968367 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3357527 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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