Legacy Specialty Pharmacy Corp

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

LEGACY SPECIALTY PHARMACY CORP

Practice address

6668 Fresh Pond Rd
Ridgewood, NY 11385-3912

Phone

(718) 456-7300

Fax

(718) 456-7302

NPI assigned

Jul 28, 2019

Last updated

Sep 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matthew Sanger

Title

Managing Member

Phone

(718) 456-7300

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ilios Guma, R.PH

  • Pharmacist
  • Brooklyn, NY
  • NPI 1760931885
  NPD
• Mariam E Hanna

  • Pharmacist
  • Ridgewood, NY
  • NPI 1790697589
  NPD (past)
• Gabrielle Khan, PHARMD

  • Pharmacist
  • North Baldwin, NY
  • NPI 1932988565
  NPD (past)
• Malak G Sadek

  • Pharmacist
  • Ridgewood, NY
  • NPI 1619888302
  NPD (past)

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

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1538713524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6851 FRESH POND RD # 3STO",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855296",
            "telephone_number": "718-456-7300",
            "fax_number": "718-456-7302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6668 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113853912",
            "telephone_number": "718-456-7300",
            "fax_number": "718-456-7302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SPECIALTY PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-28",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "SANGER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-456-7300"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tatyana M. Ledovsky, M.D.
• Karen Lai Ping Lee Miu
• David Hyun Lee, PHARM D
• Steven Jian Ping Lee, PHARMD.
• Wayne Lee, LMSW
• Jessica Lenard, PHARMD
• Michael Levenberg, RPH
• Cassidy Leverett, LMSW
• Lewis Bass DO PC
• Sophia Li, CCC-SLP

• Pharmacy in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.