Green Forest Market Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

032321 Issued in NY

Legal business name

GREEN FOREST MARKET INC.

Doing business as

GREEN FOREST PHARMACY

Practice address

1520 Avenue M
Brooklyn, NY 11230-5267

Phone

(929) 333-9669

Fax

(929) 333-9667

NPI assigned

Nov 26, 2013

Organization subpart

No

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

Authorized official

Name

Vitaliy Chertkov

Title

President

Phone

(929) 333-9669

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GREEN FOREST PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Locations

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1245660380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 AVENUE M",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112305267",
            "telephone_number": "929-333-9669",
            "fax_number": "929-333-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 AVENUE M",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112305267",
            "telephone_number": "929-333-9669",
            "fax_number": "929-333-9667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN FOREST MARKET INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-26",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "CHERTKOV",
        "authorized_official_first_name": "VITALIY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "929-333-9669"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "032321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03821950",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREEN FOREST PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Christopher Greczek, PA-C
• Marisa Anne Greechan, RN, CPNP
• Norman H Greeley, M.D.
• Green Bell Health, Inc.
• Green Bell Medical, New York, PC
• Green Health Consulting, LLC
• Green Leaf Pharmacy Inc
• Green Light Physical Therapy PC
• Juliana Susannah Green Peters
• Green Plus Pharmacy Inc

• Community/Retail Pharmacy in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; 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.