NPIMap

Organization Active NPI

Waldbaum Inc

Doing business as Waldbaums Pharmacy

  • Pharmacy
  • Shirley, NY
National Provider Identifier
1184649733
Registry record updated Nov 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
020594 Issued in NY
Legal business name
WALDBAUM INC
Doing business as
Waldbaums Pharmacy
Practice address
999 Montauk Hwy
Shirley, NY 11967-2130
Phone
(631) 281-8924
Fax
(631) 395-1275
NPI assigned
Jul 13, 2006
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2007

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

Authorized official

Name
Susan Kijowski
Title
Pharmacy Specialist
Phone
(201) 571-8326

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 020594 NY
Pharmacy 333600000X 020594 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

999 Montauk Hwy
Shirley, NY 11967-2130

Mailing address

999 Montauk Hwy
Shirley, NY 11967-2130

Other identifiers 2

IdentifierTypeStateIssuer
3396151OtherOTHER ID NUMBER-COMMERCIAL NUMBER
01181180MedicaidNY

Other names 1

  • WALDBAUMS PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Waldbaum Inc7 organizations share this tax ID, including this one
Part of
Great Atlantic Pacific Tea Company Inc

Other organizations with this tax ID 6

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

Locations

999 Montauk Hwy
Shirley, NY 11967
Phone (631) 281-8924

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195344000000",
    "number": "1184649733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 MONTAUK HWY",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119672130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 MONTAUK HWY",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119672130",
            "telephone_number": "631-281-8924",
            "fax_number": "631-395-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDBAUM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-18",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PHARMACY SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "020594",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "020594",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3396151",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01181180",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDBAUMS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shirley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.