1659369783 NPI number — 5TH AVE DRUG, INC

Table of content: RACHEL DIANE LUMB RN (NPI 1336056597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659369783 NPI number — 5TH AVE DRUG, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
5TH AVE DRUG, 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:
1659369783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 B FIFTH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-231-4960
Provider Business Mailing Address Fax Number:
631-231-0368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-231-4960
Provider Business Practice Location Address Fax Number:
631-231-0368
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
TOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-231-4960

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 020130 , 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: 01125584 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3394020 . This is a "NAPB" identifier . This identifiers is of the category "OTHER".




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