Provider Demographics
NPI:1407281835
Name:200 BASSETT ROAD OPERATING COMPANY, LLC
Entity type:Organization
Organization Name:200 BASSETT ROAD OPERATING COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-802-7609
Mailing Address - Street 1:641 LEXINGTON AVE
Mailing Address - Street 2:31ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4503
Mailing Address - Country:US
Mailing Address - Phone:212-802-7609
Mailing Address - Fax:646-924-0520
Practice Address - Street 1:200 BASSETT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2639
Practice Address - Country:US
Practice Address - Phone:716-689-6681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:200 BASETT ROAD OPERATING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0319323336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031932OtherNY STATE BOARD OF PHARMACY REGISTRATION