Provider Demographics
NPI:1053388579
Name:BIRAJ PHARMACY CORP
Entity type:Organization
Organization Name:BIRAJ PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:P
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-928-8082
Mailing Address - Street 1:1280 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7204
Mailing Address - Country:US
Mailing Address - Phone:212-928-8082
Mailing Address - Fax:212-928-8082
Practice Address - Street 1:1280 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7204
Practice Address - Country:US
Practice Address - Phone:212-928-8082
Practice Address - Fax:212-928-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3339872OtherNCPDP ID
NY01478651Medicaid
NY01478651Medicaid
NY01478651Medicaid