1164425336 NPI number — BIOSCRIP PHARMACY(NY), INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164425336 NPI number — BIOSCRIP PHARMACY(NY), INC

Employer Identification Number (EIN):

Provider Organization Name:

BIOSCRIP PHARMACY(NY), 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 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:

1164425336

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/12/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1600 BROADWAY

Provider Second Line Business Mailing Address:

SUITE 700

Provider Business Mailing Address City Name:

DENVER

Provider Business Mailing Address State Name:

CO

Provider Business Mailing Address Postal Code:

80202

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

720-697-5171

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1 VERMONT DR.

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LAKE SUCCESS

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11042

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

877-501-0108

Provider Business Practice Location Address Fax Number:

516-355-9322

Provider Enumeration Date:

05/23/2005

Authorized Official Last Name:

SHAPIRO

Authorized Official First Name:

MICHAEL

Authorized Official Middle Name:

Authorized Official Title or Position:

PRESIDENT & CFO

Authorized Official Telephone Number:

800-879-6137

• Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 333600000X , with the licence number: 028120 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: PH01478 . This is a "LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
• Identifier: 003095199 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 6754210 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: A9-0000425 . This is a "LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
• Identifier: MO40001165 . This is a "LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
• Identifier: PHN10000 . This is a "LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 021198900 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 021820 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 10483 . This is a "LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: NR0135 . This is a "LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: 1009850 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
• Identifier: 2004020573 . This is a "LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 6754201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: PMP-237 . This is a "LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 1009850 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 28RO00023400 . This is a "LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 64000309A . This is a "LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: PCN.0000299 . This is a "LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 17218 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 02244640 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".