1235264052 NPI number — CRICOR HOLDINGS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235264052 NPI number — CRICOR HOLDINGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRICOR HOLDINGS, 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:
1235264052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4202 GREENPOINT AVE
Provider Second Line Business Mailing Address:
B
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11104-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-433-3091
Provider Business Mailing Address Fax Number:
718-433-1657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4202 GREENPOINT AVE
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-433-3091
Provider Business Practice Location Address Fax Number:
718-433-1657
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOLMAIAN
Authorized Official First Name:
SIMON
Authorized Official Middle Name:
CRICOR
Authorized Official Title or Position:
SUPERVISING PHARMACIST
Authorized Official Telephone Number:
718-433-3091

Provider Taxonomy Codes

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

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

  • Identifier: 02134114 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3321145 . This is a "NCPDP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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