1093397663 NPI number — WORKERS HEALTH RX. INC

Table of content: (NPI 1093397663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093397663 NPI number — WORKERS HEALTH RX. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKERS HEALTH RX. 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:
Provider Other Organization Name Type Code:
6
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:
1093397663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DUPONT ST STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-626-1384
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DUPONT ST STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-777-8299
Provider Business Practice Location Address Fax Number:
516-464-2520
Provider Enumeration Date:
04/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
WIENER
Authorized Official First Name:
MARC
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
516-464-2532

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038701 . This is a "NEW YORK BOP REGISTARTION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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