Individual provider Active NPI

Jason Todd Trombley, RPH

  • Pharmacist
  • Central Square, NY
National Provider Identifier
1164605176
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
047501-1 Issued in NY
Practice address
3018 East Ave
Central Square, NY 13036-2615
Phone
(315) 668-0413
Fax
(315) 668-0415
NPI assigned
Dec 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 047501-1 NY Primary

Addresses

Primary practice location

3018 East Ave
Central Square, NY 13036-2615

Mailing address

3018 East Ave
Central Square, NY 13036-2615
Phone (315) 668-0413

Other identifiers 2

IdentifierTypeStateIssuer
02329633MedicaidNY
1316964489OtherNYNPI

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
047501-1NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197417600000",
    "number": "1164605176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3018 EAST AVE",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130362615",
            "telephone_number": "315-668-0413",
            "fax_number": "315-668-0415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3018 EAST AVE",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130362615",
            "telephone_number": "315-668-0413",
            "fax_number": "315-668-0415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TROMBLEY",
        "first_name": "JASON",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-12",
        "last_updated": "2007-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "047501-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02329633",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1316964489",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Central Square, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2007; 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.