Rite Aid of New York Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

030904 Issued in NY

Legal business name

RITE AID OF NEW YORK INC

Practice address

76 Pike Street
Port Jervis, NY 12771-2414

Phone

(845) 856-8342

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Jennifer Zorek

Title

Sr Manager Provider Enrollment

Phone

(717) 975-5937

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• RITE AID PHARMACY 00742 Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1255420980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NEWBERRY COMMONS",
            "city": "ETTERS",
            "state": "PA",
            "postal_code": "173199363",
            "telephone_number": "717-761-2633",
            "fax_number": "717-975-8659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 PIKE STREET",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127712414",
            "telephone_number": "845-856-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RITE AID OF NEW YORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "ZOREK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "SR MANAGER PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "717-975-5937"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3316242",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICAID",
            "identifier": "1007631000017",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00315875",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 00742",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Port Jervis Volunteer Ambulance Corps Inc
• Sheila Quinn
• Ralph Edward Bowman, Physician PC
• Mary Ann Ricci, CARC
• Elaine Margaret Ridley, RD
• Yesenia Rivera, LCSW
• Kiera Lindgren Robertson, ATC
• Wendy Dawn Rodriguez, FNP-BC
• Susan Rogowski, OTR/L, MPS, DROT
• Ronald M Roshe, MD

• Community/Retail Pharmacy in Port Jervis, NY
• Providers in Port Jervis, 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 Jul 28, 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.