NPIMap

Individual provider Active NPI

Jeffrey G Middendorf, RPH

  • Pharmacist
  • Glenmont, NY
National Provider Identifier
1295912947
Registry record updated Mar 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
044565 Issued in NY
Practice address
392 Feura Bush Rd
Glenmont, NY 12077-2954
Phone
(518) 462-5507
Fax
(518) 462-3721
NPI assigned
Jan 24, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 044565 NY Primary
Pharmacist 183500000X RP438289 PA

Addresses

Primary practice location

392 Feura Bush Rd
Glenmont, NY 12077-2954

Mailing address

392 Feura Bush Rd
Glenmont, NY 12077-2954
Phone (518) 462-5507

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
044565NYMDPharmacist
RP438289PAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
CVS Albany LLC Past Accepting new patients
CVS Albany LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269475200000",
    "number": "1295912947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "392 FEURA BUSH RD",
            "city": "GLENMONT",
            "state": "NY",
            "postal_code": "120772954",
            "telephone_number": "518-462-5507",
            "fax_number": "518-462-3721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "392 FEURA BUSH RD",
            "city": "GLENMONT",
            "state": "NY",
            "postal_code": "120772954",
            "telephone_number": "518-462-5507",
            "fax_number": "518-462-3721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDENDORF",
        "first_name": "JEFFREY",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-24",
        "last_updated": "2010-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "044565",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP438289",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenmont, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; 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.