1689804346 NPI number — PRINCETON ADVANCED TECHNOLOGIES LLC

Table of content: (NPI 1689804346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689804346 NPI number — PRINCETON ADVANCED TECHNOLOGIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCETON ADVANCED TECHNOLOGIES LLC
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:
SCHODACK PHARMACY
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:
1689804346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 MILLER RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
CASTLETON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12033-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-512-5181
Provider Business Mailing Address Fax Number:
518-512-5184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 MILLER RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
CASTLETON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12033-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-512-5181
Provider Business Practice Location Address Fax Number:
518-512-5184
Provider Enumeration Date:
07/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BARRANCA
Authorized Official First Name:
AUGUSTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST / OWNER
Authorized Official Telephone Number:
518-512-5181

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  029581 , 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: 3361829 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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