Starrett City Pharmacy, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

025076 Issued in NY

Legal business name

STARRETT CITY PHARMACY, LLC

Practice address

1110 Pennsylvania Ave
Brooklyn, NY 11207-9061

Phone

(718) 257-8777

Fax

(718) 257-8884

NPI assigned

Oct 19, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Igor Vaysbaum, RPHNPI 1154653293

Title

President

Phone

(718) 257-8777

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Tax ID family

Starrett City Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Starrett City Pharmacy, LLC

  dba starrett city pharmacy LTC

  • Long Term Care Pharmacy
  • Brooklyn, NY
  • NPI 1487449526
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Starrett City Pharmacy, LLC

  dba starrett city pharmacy LTC

  • Long Term Care Pharmacy
  • Brooklyn, NY
  • NPI 1487449526
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Igor Vaysbaum, RPH

  • Pharmacist
  • Brooklyn, NY
  • NPI 1154653293
  NPD Authorized official

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033108311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 PENNSYLVANIA AVE",
            "address_2": "SUITE # 12",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112079061",
            "telephone_number": "718-257-8777",
            "fax_number": "718-257-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 PENNSYLVANIA AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112079061",
            "telephone_number": "718-257-8777",
            "fax_number": "718-257-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARRETT CITY PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAYSBAUM",
        "authorized_official_first_name": "IGOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-257-8777",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "025076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCDP",
            "identifier": "3322308",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02168005",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elena Starosta, MD
• Amanda Jane Starr, CCC-SLP
• Starrett City Dental Group
• Starrett City Dental Group Associates, PC
• Starrett City Medical of New York LLC
• Starrett City Pharmacy, LLC (starrett city pharmacy LTC)
• Starrett Podiatry, LLC
• Stars Dental
• Stars Dental P.C.
• Stars Dental P.C.

• Pharmacy in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.