Basic Information
Provider Information
NPI: 1003139924
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PROENCA
FirstName: VITOR
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: R.PH.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3164 21ST ST
Address2: MERLIN CHEMISTS, INC
City: LONG ISLAND CITY
State: NY
PostalCode: 111064573
CountryCode: US
TelephoneNumber: 7182678900
FaxNumber: 7172678912
Practice Location
Address1: 3164 21ST ST
Address2: MERLIN CHEMISTS, INC
City: LONG ISLAND CITY
State: NY
PostalCode: 111064573
CountryCode: US
TelephoneNumber: 7182678900
FaxNumber: 7172678912
Other Information
ProviderEnumerationDate: 03/05/2010
LastUpdateDate: 03/05/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X041927NYY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home