Active NPI
Shoprite Supermarkets, Inc
- Community/Retail Pharmacy
- Mohegan Lake, NY
National Provider Identifier
1104965771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 025414
- 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
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Melissa Figueroa Rivera
- Title
- Third Party Administrator
- Phone
- (732) 521-8439
Other NPIs on the same Medicare enrollment 15
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- White Plains, NY
- NPI 1114232097
O20110110000400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records 1
Medicare enrollment files| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
National Provider DirectoryLocations
2094 E Main St
Cortlandt Manor, NY 10567
Phone (845) 739-7474
3140 E Main St
Ste 300
Mohegan Lake, NY 10547
Phone (914) 739-7474
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 025414 | NY | Primary |
Addresses
NPPES NPI RegistryPrimary 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
Other identifiers 2
NPPES NPI Registry| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00582701 | Medicaid | NY | |
| 3326077 | Other | NY | NCPDP |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 16, 2019.
{
"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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00582701",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "3326077",
"state": "NY"
}
],
"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.