NPIMap

Organization Active NPI

Pathmark Stores Inc

Doing business as Pathmark Pharmacy

  • Pharmacy
  • Staten Island, NY
National Provider Identifier
1053418814
Registry record updated Jul 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
014471 Issued in NY
Legal business name
PATHMARK STORES INC
Doing business as
Pathmark Pharmacy
Practice address
2660 Hylan Blvd
Staten Island, NY 10306-4355
Phone
(718) 979-1005
Fax
(718) 980-5512
NPI assigned
Sep 20, 2006
Last updated
Jul 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2007

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

Authorized official

Name
Mindi Norelli
Title
Admin
Phone
(732) 499-3313

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 014471 NY Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

2660 Hylan Blvd
Staten Island, NY 10306-4355

Mailing address

200 Milik St
M115
Carteret, NJ 07008-1102

Other identifiers 2

IdentifierTypeStateIssuer
3314173OtherOTHER ID NUMBER-COMMERCIAL NUMBER
00264833MedicaidNY

Other names 1

  • PATHMARK PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pathmark Pharmacy10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1053418814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILIK ST",
            "address_2": "M115",
            "city": "CARTERET",
            "state": "NJ",
            "postal_code": "070081102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2660 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064355",
            "telephone_number": "718-979-1005",
            "fax_number": "718-980-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "NORELLI",
        "authorized_official_first_name": "MINDI",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "732-499-3313"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "014471",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3314173",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00264833",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.