Individual provider Active NPI

Ayman S Shenoda, RPH

  • Pharmacist
  • Nutley, NJ
National Provider Identifier
1124597067
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
28RI03758800 Issued in NJ
Practice address
217 Harrison St
Nutley, NJ 07110-2637
Phone
(973) 667-5773
NPI assigned
Nov 21, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 065023 NY
Pharmacist 183500000X 28RI03758800 NJ Primary

Addresses

Primary practice location

217 Harrison St
Nutley, NJ 07110-2637

Mailing address

124 Sussex St Apt D
Westfield, NJ 07090-1515

Other identifiers 2

IdentifierTypeStateIssuer
065023OtherNYNY BOARD OF PHARMACY
28RI03758800OtherNJNJ BOARD OF PHARMACY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
065023NYMDDentist
28RI03758800NJMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1124597067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SUSSEX ST APT D",
            "city": "WESTFIELD",
            "state": "NJ",
            "postal_code": "070901515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 HARRISON ST",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071102637",
            "telephone_number": "973-667-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHENODA",
        "first_name": "AYMAN",
        "middle_name": "S",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-21",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "065023",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI03758800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY BOARD OF PHARMACY",
            "identifier": "065023",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ BOARD OF PHARMACY",
            "identifier": "28RI03758800",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nutley, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.