NPIMap

Organization Active NPI

Newyork-Presbyterian/Queens

  • Community/Retail Pharmacy
  • Flushing, NY
National Provider Identifier
1114397007
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
033759 Issued in NY
Legal business name
NEWYORK-PRESBYTERIAN/QUEENS
Doing business as
NewYork-Presbyterian/Queens
Practice address
5645 Main St
Flushing, NY 11355-5045
Phone
(718) 670-1545
Fax
(718) 670-1316
NPI assigned
Oct 5, 2015
Last updated
Nov 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Authorized official

Name
Alexander Ferdinand Melchert
Title
Director of Pharmacy
Phone
(718) 670-1545

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 033759 NY Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

5645 Main St
Flushing, NY 11355-5045

Mailing address

5645 Main St
Flushing, NY 11355-5045
Phone (718) 670-1545

Other identifiers 2

IdentifierTypeStateIssuer
04683414MedicaidNY
2154404OtherPK

Other names 1

  • NewYork-Presbyterian/Queens Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161003002299 NY Part B Supplier - Pharmacy 7315839933 Practice locations: Flushing, NY
O20190128001287 NY DME Supplier - Pharmacy 7315839933 Practice locations: Flushing, NY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
New York-Presbyterian-Queens5645 Main St, Flushing, NY 11355-5045(718) 670-1728 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Insulin Infusion Pumps and/or Supplies|Nebulizer Equipment and/or Supplies Accepts assignmentParticipating since May 6, 1998

National Provider Directory

National Provider Directory
Tax ID family
Nyhmcq Surgical PA50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1444003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1114397007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-670-1545",
            "fax_number": "718-670-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-670-1545",
            "fax_number": "718-670-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWYORK-PRESBYTERIAN/QUEENS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-05",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "MELCHERT",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "FERDINAND",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "718-670-1545"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "033759",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04683414",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2154404",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NewYork-Presbyterian/Queens",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NewYork-Presbyterian/Queens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.