NPIMap

Organization Active NPI

Shoprite Supermarkets, Inc

  • Community/Retail Pharmacy
  • Mohegan Lake, NY
National Provider Identifier
1104965771
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
025414 Issued in NY
Legal business name
SHOPRITE SUPERMARKETS, INC
Practice address
3140 E Main St Ste 300
Mohegan Lake, NY 10547
Phone
(914) 739-7474
NPI assigned
Feb 6, 2007
Last updated
Jan 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Authorized official

Name
Melissa Figueroa Rivera
Title
Third Party Administrator
Phone
(732) 521-8439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 025414 NY Primary

Addresses

Primary practice location

3140 E Main St Ste 300
Mohegan Lake, NY 10547

Mailing address

3140 E Main St Ste 300
Mohegan Lake, NY 10547-1517
Phone (914) 739-7474

Other practice location 1

2094 E Main Street
Cortlandt Manor, NY 10567
Phone (845) 739-7474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110110000400 NY Part B Supplier - Mass Immunization (Roster Biller Only) 9436278413 15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carmel, NY; Hudson, NY; Monticello, NY

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

Locations

3140 E Main St
Ste 300
Mohegan Lake, NY 10547
Phone (914) 739-7474

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1104965771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3140 E MAIN ST STE 300",
            "city": "MOHEGAN LAKE",
            "state": "NY",
            "postal_code": "105471517",
            "telephone_number": "914-739-7474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3140 E MAIN ST STE 300",
            "city": "MOHEGAN LAKE",
            "state": "NY",
            "postal_code": "10547",
            "telephone_number": "914-739-7474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2094 E Main Street",
            "address_purpose": "LOCATION",
            "city": "Cortlandt Manor",
            "state": "NY",
            "postal_code": "10567",
            "country_code": "US",
            "telephone_number": "845-739-7474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHOPRITE SUPERMARKETS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2019-01-16",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA RIVERA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "732-521-8439"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "025414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mohegan Lake, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; 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.