Individual provider Active NPI

Anthony Maida

  • Pharmacist
  • Northport, NY
National Provider Identifier
1558548404
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
037788 Issued in NY
Practice address
10 Fort Salonga Rd Ste 3
Northport, NY 11768-1400
Phone
(631) 757-5588
NPI assigned
Jan 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 037788 NY Primary

Addresses

Primary practice location

10 Fort Salonga Rd Ste 3
Northport, NY 11768-1400

Mailing address

111 Depot Rd
Huntington Station, NY 11746-1723

Other practice location 1

111 Depot Rd
Huntington Station, NY 11746-1723
Phone (631) 271-8821

Other identifiers 1

IdentifierTypeStateIssuer
02101031MedicaidNY

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

Practice roles

OrganizationSpecialtyStatusNew patients
CVS Albany LLC Past Accepting new patients
CVS Albany LLC PastSince Dec 6, 2020 Accepting new patients
CVS Albany LLC PastSince Dec 6, 2020 Accepting new patients

Organizations & group practices 3

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": "1201046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1558548404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DEPOT RD",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117461723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FORT SALONGA RD STE 3",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681400",
            "telephone_number": "631-757-5588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Depot Rd",
            "address_purpose": "LOCATION",
            "city": "Huntington Station",
            "state": "NY",
            "postal_code": "117461723",
            "country_code": "US",
            "telephone_number": "631-271-8821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAIDA",
        "first_name": "ANTHONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-23",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "037788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02101031",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.