Active NPI
Latchman Bisram
- Pharmacist
- South Ozone Park, NY
National Provider Identifier
1649805847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 066580
- Practice address
- 11902 Rockaway Blvd
South Ozone Park, NY 11420-2422 - Phone
- (718) 529-9503
- NPI assigned
- Mar 8, 2020
- 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 | 066580 | NY | Primary |
Addresses
Primary practice location
11902 Rockaway Blvd
South Ozone Park, NY 11420-2422
Mailing address
10943 142ND St
Jamaica, NY 11435-5505
Phone (347) 358-6244
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 |
|---|---|---|---|
| 066580 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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
- South Ozone Park, NY
- NPI 1639184781
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583625600000",
"number": "1649805847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10943 142ND ST",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114355505",
"telephone_number": "347-358-6244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11902 ROCKAWAY BLVD",
"city": "SOUTH OZONE PARK",
"state": "NY",
"postal_code": "114202422",
"telephone_number": "718-529-9503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISRAM",
"first_name": "LATCHMAN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-08",
"last_updated": "2020-03-08",
"certification_date": "2020-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "066580",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Ozone Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.