Active NPI
Gilbert Hathaway
- Pharmacist
- Patchogue, NY
National Provider Identifier
1508044736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 31428
- Practice address
- 399 Route 112
Patchogue, NY 11772-1849 - Phone
- (631) 758-2154
- Fax
- (631) 758-3473
- NPI assigned
- Feb 11, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 31428 | NY | Primary |
Addresses
Primary practice location
399 Route 112
Patchogue, NY 11772-1849
Mailing address
19 Rolling Hills Dr
Ridge, NY 11961-2307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31428 | Other | NY | RPH STATE LICENSE NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31428 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathmark Stores Inc | Past | Accepting new patients | |
| Pathmark Stores Inc | 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.
-
- Pharmacy
- Staten Island, NY
- NPI 1558461590
-
- Pharmacy
- Patchogue, NY
- NPI 1780781542
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202688000000",
"number": "1508044736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 ROLLING HILLS DR",
"city": "RIDGE",
"state": "NY",
"postal_code": "119612307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "399 ROUTE 112",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117721849",
"telephone_number": "631-758-2154",
"fax_number": "631-758-3473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATHAWAY",
"first_name": "GILBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-11",
"last_updated": "2008-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "31428",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RPH STATE LICENSE NUMBER",
"identifier": "31428",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.