Provider Demographics
NPI:1124334735
Name:ATLANTIC HEIGHTS SPECIALTY SCRIPT CORP
Entity type:Organization
Organization Name:ATLANTIC HEIGHTS SPECIALTY SCRIPT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-648-0933
Mailing Address - Street 1:349 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5551
Mailing Address - Country:US
Mailing Address - Phone:718-780-1671
Mailing Address - Fax:347-521-2095
Practice Address - Street 1:349 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5551
Practice Address - Country:US
Practice Address - Phone:718-780-1671
Practice Address - Fax:347-521-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3261070Medicaid
2130721OtherPK