Provider Demographics
NPI:1215973136
Name:KIRYAS JOEL PHARMACY INC
Entity type:Organization
Organization Name:KIRYAS JOEL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-783-3399
Mailing Address - Street 1:51 FOREST RD STE 211
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2936
Mailing Address - Country:US
Mailing Address - Phone:845-783-5787
Mailing Address - Fax:845-783-7446
Practice Address - Street 1:51 FOREST RD STE 211
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2936
Practice Address - Country:US
Practice Address - Phone:845-783-5787
Practice Address - Fax:845-783-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0186443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2063464OtherPK
NY00894404Medicaid
NY00894404Medicaid