Organization Active NPI

Leonaum Pharmacy Inc.

  • Community/Retail Pharmacy
  • Brooklyn, NY
National Provider Identifier
1124034640
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
026314 Issued in NY
Legal business name
LEONAUM PHARMACY INC.
Practice address
4910 Fort Hamilton Pkwy
Brooklyn, NY 11219-3344
Phone
(718) 437-4699
Fax
(718) 437-0796
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Roman Pinhasov
Title
President
Phone
(718) 437-4699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 026314 NY Primary

Addresses

Primary practice location

4910 Fort Hamilton Pkwy
Brooklyn, NY 11219-3344

Mailing address

4910 Fort Hamilton Pkwy
Brooklyn, NY 11219-3344
Phone (718) 437-4699

Other identifiers 1

IdentifierTypeStateIssuer
02425414MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250530001583 NY Part B Supplier - Mass Immunization (Roster Biller Only) 9335342518 Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

4910 Fort Hamilton Pkwy
Brooklyn, NY 11219
Phone (347) 204-5198

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1124034640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 FORT HAMILTON PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193344",
            "telephone_number": "718-437-4699",
            "fax_number": "718-437-0796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 FORT HAMILTON PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193344",
            "telephone_number": "718-437-4699",
            "fax_number": "718-437-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEONAUM PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "PINHASOV",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-437-4699"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "026314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02425414",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.