158TH Street Neighborhood Pharmacy, LLC

Key facts

NPI

1215048152

Entity type

Organization (NPI type 2)

Primary specialty

Durable Medical Equipment & Medical Supplies 332B00000X

License

026148 (NY)

Legal business name

158TH STREET NEIGHBORHOOD PHARMACY, LLC

Practice address

3103 3Rd Ave
Bronx, NY 10451-4688

Phone

(718) 585-6188

Fax

(718) 585-6653

NPI assigned

Aug 31, 2006

Organization subpart

No

Authorized official

Name

Noam Avidar

Title

Memeber

Phone

(718) 585-6188

Corporate family (same tax ID) 1

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

• 158TH Street Neighborhood Pharmacy, LLC Pharmacy · Bronx, NY · NPI 1528139318
  NPD tax ID

National Provider Directory

Tax ID family

158TH Street Neighborhood Pharmacy LLC (2 organizations share this tax ID)

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215048152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514688",
            "telephone_number": "718-585-6188",
            "fax_number": "718-585-6653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514688",
            "telephone_number": "718-585-6188",
            "fax_number": "718-585-6653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "158TH STREET NEIGHBORHOOD PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AVIDAR",
        "authorized_official_first_name": "NOAM",
        "authorized_official_title_or_position": "MEMEBER",
        "authorized_official_telephone_number": "718-585-6188"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "026148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02519551",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Bronx, NY · Durable Medical Equipment & Medical Supplies in New York