Provider Demographics
NPI:1396073060
Name:NACSIP INC
Entity type:Organization
Organization Name:NACSIP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:R.PH,CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAGI
Authorized Official - Middle Name:
Authorized Official - Last Name:WISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-208-0424
Mailing Address - Street 1:559 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4712
Mailing Address - Country:US
Mailing Address - Phone:845-208-0424
Mailing Address - Fax:845-208-0425
Practice Address - Street 1:559 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4712
Practice Address - Country:US
Practice Address - Phone:845-208-0424
Practice Address - Fax:845-208-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029930333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3364116OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3364116OtherNCPDP PROVIDER IDENTIFICATION NUMBER