Provider Demographics
NPI:1699135368
Name:IPPC OF NEW YORK LLC
Entity type:Organization
Organization Name:IPPC OF NEW YORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-617-8686
Mailing Address - Street 1:101 FAIRCHILD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1725
Mailing Address - Country:US
Mailing Address - Phone:516-544-4311
Mailing Address - Fax:516-544-4314
Practice Address - Street 1:101 FAIRCHILD AVE STE 5
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1725
Practice Address - Country:US
Practice Address - Phone:516-544-4311
Practice Address - Fax:516-544-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0343593336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159009OtherPK