NPIMap

Organization Active NPI

Healthsource Pharmacy Inc

Doing business as Healthsource Pharmacy

  • Long Term Care Pharmacy
  • New York, NY
National Provider Identifier
1679318125
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
HEALTHSOURCE PHARMACY INC
Doing business as
Healthsource Pharmacy
Practice address
1296 2ND Ave
New York, NY 10065-5707
Phone
(212) 794-8700
NPI assigned
Jun 26, 2024
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTHSOURCE PHARMACY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Boris NiyazovNPI 1497928345
Title
President
Phone
(212) 794-8700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X NU Primary

Addresses

Primary practice location

1296 2ND Ave
New York, NY 10065-5707

Mailing address

1296 2ND Ave
New York, NY 10065-5707

Other names 1

  • Healthsource Pharmacy Doing business as

National Provider Directory

National Provider Directory
Part of
Healthsource Pharmacy Inc

Locations

1296 2nd Ave
New York, NY 10065
Phone (212) 794-8700

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1679318125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1296 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100655707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100655707",
            "telephone_number": "212-794-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHSOURCE PHARMACY INC",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "NIYAZOV",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-794-8700"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthsource Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.