Active NPI
Ellen Kim
- Pharmacist
- New York, NY
National Provider Identifier
1689847584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 046350
- Practice address
- 1000 1St Ave
New York, NY 10022-4105 - Phone
- (212) 310-0111
- NPI assigned
- Apr 11, 2008
- Sex
- Female
- 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 | 046350 | NY | Primary |
Addresses
Primary practice location
1000 1St Ave
New York, NY 10022-4105
Mailing address
5 E 67TH St
Apt 5D
New York, NY 10065-5823
Phone (917) 612-4558
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 |
|---|---|---|---|
| 046350 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthsource Pharmacy III B Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba HealthSource Pharmacy
- Community/Retail Pharmacy
- New York, NY
- NPI 1962792176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331078400000",
"number": "1689847584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 E 67TH ST",
"address_2": "APT 5D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100655823",
"telephone_number": "917-612-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 1ST AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100224105",
"telephone_number": "212-310-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ELLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-11",
"last_updated": "2012-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "046350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Mar 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.