Waldbaum Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

024751 Issued in NY

Legal business name

WALDBAUM INC

Practice address

812 Montauk Hwy
Center Moriches, NY 11934-2212

Phone

(631) 874-9025

Fax

(631) 874-2381

NPI assigned

Jul 13, 2006

Organization subpart

Yes

Parent organization

THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INCAs reported in NPPES

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

Authorized official

Name

Susan Kijowski

Title

Pharmacy Specialist

Phone

(201) 571-8326

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• WALDBAUMS PHARMACY Doing business as

Part of

Great Atlantic Pacific Tea Company Inc

Locations

Practitioners 2

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

• Yvonne Clark O'Brien, RPH

  • Pharmacist
  • Center Moriches, NY
  • NPI 1568755270
  NPD (past)
• Nellie Toro, BS RPH

  • Pharmacist
  • Center Moriches, NY
  • NPI 1750559316
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194566400000",
    "number": "1669497129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 MONTAUK HWY",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119342212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 MONTAUK HWY",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119342212",
            "telephone_number": "631-874-9025",
            "fax_number": "631-874-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDBAUM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-09",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PHARMACY SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "024751",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "024751",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3316482",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02094177",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDBAUMS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nellie Toro, BS RPH
• Tiesha Shanay Trent, RN
• Angela Nichole Vetri
• Patricia E Voelpel, ANP
• Melissa Vogt, LCSW
• Susan Diana Walker, M.D.
• Wayne M. Gurnick Ms, LCSW P.C.
• Andrea Weisse
• Patrice Westenberger, NP
• Mikayla Weybrecht

• Pharmacy in Center Moriches, NY
• Providers in Center Moriches, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; 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.