Provider Demographics
NPI:1588910392
Name:GRAMERCY DRUGS INC
Entity type:Organization
Organization Name:GRAMERCY DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-622-2772
Mailing Address - Street 1:2218 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2508
Mailing Address - Country:US
Mailing Address - Phone:212-532-0022
Mailing Address - Fax:212-532-0044
Practice Address - Street 1:2218 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2508
Practice Address - Country:US
Practice Address - Phone:212-532-0022
Practice Address - Fax:212-532-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0313243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03490333Medicaid
2136274OtherPK
NY03409333Medicaid
NYFG3391618OtherDEA
NY6714790001Medicare PIN