Plymouth Park Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS001207900 Issued in NJ

Legal business name

PLYMOUTH PARK PHARMACY INC

Practice address

11 12 Saddle River Rd
Fair Lawn, NJ 07410-5786

Phone

(201) 797-0006

Fax

(201) 797-0007

NPI assigned

Jun 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bryan Scott PiskadloNPI 1801231725

Title

President

Phone

(201) 797-0006

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Scott Piskadlo, RPH

  • Pharmacist
  • Fair Lawn, NJ
  • NPI 1801231725
  NPD Authorized official
• Kristina Marie Torregrossa, PHARMD

  • Pharmacist
  • Fair Lawn, NJ
  • NPI 1710867668
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570924800000",
    "number": "1023053469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 12 SADDLE RIVER RD",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074105786",
            "telephone_number": "201-797-0006",
            "fax_number": "201-797-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 12 SADDLE RIVER RD",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074105786",
            "telephone_number": "201-797-0006",
            "fax_number": "201-797-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH PARK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2019-10-13",
        "status": "A",
        "authorized_official_last_name": "PISKADLO",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-797-0006"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS001207900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0698628",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2055710",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wojciech Piwowarczyk, PT, DPT, CSCS
• John Angelo Placca, PA
• Plaza Health and Wellness Center, LLC
• Plaza Health Center, LLC
• Plaza Wellness & Health Center LLC
• Point to Point Transportation, LLC
• Marina Polyak
• Boris L Prakhina, M.D.
• Precision Physical Therapy, Inc
• Preferred Life Medical Services

• Community/Retail Pharmacy in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.