NPIMap

Organization Active NPI

Waldbaum Inc

  • Pharmacy
  • Long Beach, NY
National Provider Identifier
1104841667
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
024839 Issued in NY
Legal business name
WALDBAUM INC
Practice address
85 E Park Ave
Long Beach, NY 11561-3597
Phone
(516) 889-6704
Fax
(516) 889-6709
NPI assigned
Jul 13, 2006
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Susan Kijowski
Title
Pharmacy Specialist
Phone
(201) 571-8326

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 024839 NJ
Pharmacy 333600000X 024839 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

85 E Park Ave
Long Beach, NY 11561-3597

Mailing address

85 E Park Ave
Long Beach, NY 11561-3597

Other identifiers 3

IdentifierTypeStateIssuer
020926020442OtherNJMEDICAID DME
02092602MedicaidNY
3317131OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • WALDBAUMS PHARMACY Doing business as

National Provider Directory

National Provider Directory
Part of
Great Atlantic Pacific Tea Company Inc

Locations

2 Westbury Ave
Carle Place, NY 11514
Phone (516) 294-6020

1530 Front St
East Meadow, NY 11554
Phone (516) 324-7500

1236 Veterans Memorial Hwy
Hauppauge, NY 11788
Phone (631) 979-3547

80 Wall St
Huntington, NY 11743
Phone (631) 421-0134

5508 Sunrise Hwy
Massapequa, NY 11758
Phone (516) 797-9672

890 Walt Whitman Rd
Melville, NY 11747
Phone (631) 385-0153

3620 Long Beach Rd
Oceanside, NY 11572
Phone (516) 766-3514

1510 Old Country Rd
Riverhead, NY 11901
Phone (631) 727-1005

4054 Nesconset Hwy
Setauket, NY 11733
Phone (631) 476-1586

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1104841667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 E PARK AVE",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115613597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E PARK AVE",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "115613597",
            "telephone_number": "516-889-6704",
            "fax_number": "516-889-6709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDBAUM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PHARMACY SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NJ",
            "license": "024839",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "024839",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "020926020442",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02092602",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3317131",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDBAUMS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.