1336360601 NPI number — MR. DAVID FISHBAIN SR. PHARMACIST

Table of content: MR. DAVID FISHBAIN SR. PHARMACIST (NPI 1336360601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336360601 NPI number — MR. DAVID FISHBAIN SR. PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHBAIN
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHBAIN
Provider Other First Name:
DAVID
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
SR.
Provider Other Credential Text:
PHARMACIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336360601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46-02 SKILLMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-729-1400
Provider Business Mailing Address Fax Number:
718-729-1406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46-02 SKILLMAN AVE
Provider Second Line Business Practice Location Address:
KRY-DBA SUNNYSIDE PHARMACY
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-729-1400
Provider Business Practice Location Address Fax Number:
718-729-1406
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  020254 , 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: 01165508 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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