NPIMap

Organization Active NPI

King Kullen Pharmacies Corp

  • Community/Retail Pharmacy
  • Bethpage, NY
National Provider Identifier
1356499313
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
026220 Issued in NY
Legal business name
KING KULLEN PHARMACIES CORP
Practice address
598 Stewart Ave
Bethpage, NY 11714-2702
Phone
(516) 822-1738
Fax
(516) 822-3754
NPI assigned
Jan 8, 2007
Organization subpart
Yes
Parent organization
KING KULLEN GROCERY CO. INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2017

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

Authorized official

Name
Albert Hesse, RPHNPI 1104009141
Title
Pharmacy Coordinator
Phone
(516) 733-7100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 026220 NY Primary

Addresses

Primary practice location

598 Stewart Ave
Bethpage, NY 11714-2702

Mailing address

King Kullen Grocery Co Inc
185 Central Ave Dept 1030
Bethpage, NY 11714-3929
Phone (516) 733-7100

Other identifiers 3

IdentifierTypeStateIssuer
3338868OtherOTHER ID NUMBER
02577851 NYMedicaidNY
3338868OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • King Kullen Pharmacy #46 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210519001061 NY Part B Supplier - Mass Immunization (Roster Biller Only) 4981813888 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Patchougue, NY; Middle Island, NY; Manorville, NY; Levittown, NY; Cutchogue, NY; Center Moriches, NY; Bethpage, NY; Huntington, NY

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

440 E Main St
Bay Shore, NY 11706
Phone (631) 414-2023

598 Stewart Ave
Bethpage, NY 11714
Phone (516) 822-1738

598 Stewart Ave
#46
Bethpage, NY 11714
Phone (516) 822-1738

552 Montauk Hwy
#15
Center Moriches, NY 11934
Phone (631) 878-9030

552 Montauk Hwy
Center Moriches, NY 11934
Phone (631) 878-9030

31525 Main Rd
#3
Cutchogue, NY 11935
Phone (631) 734-7733

50 New York Ave
Huntington, NY 11743
Phone (631) 385-7320

50 New York Ave
#40
Huntington, NY 11743
Phone (631) 385-7320

3284 Hempstead Tpke
#11
Levittown, NY 11756
Phone (516) 579-2111

460 County Road 111
#33
Manorville, NY 11949
Phone (631) 399-0346

1235 Middle Country Rd
#37
Middle Island, NY 11953
Phone (631) 924-0684

1235 Middle Country Rd
Middle Island, NY 11953
Phone (631) 924-0684

440 E Sunrise Hwy
#1
Patchogue, NY 11772
Phone (631) 758-8292

307 Independence Plz
Selden, NY 11784
Phone (631) 698-8071

271 Jericho Tpke
Syosset, NY 11791
Phone (516) 496-9452

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512691200000",
    "number": "1356499313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KING KULLEN GROCERY CO INC",
            "address_2": "185 CENTRAL AVE DEPT 1030",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143929",
            "telephone_number": "516-733-7100",
            "fax_number": "516-827-6263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "598 STEWART AVE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117142702",
            "telephone_number": "516-822-1738",
            "fax_number": "516-822-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACIES CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING KULLEN GROCERY CO. INC.",
        "enumeration_date": "2007-01-08",
        "last_updated": "2017-12-08",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "PHARMACY COORDINATOR",
        "authorized_official_telephone_number": "516-733-7100",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "026220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3338868",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02577851 NY",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3338868",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Kullen Pharmacy #46",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethpage, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; 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.