Active NPI
Ethan Simon Asedo, RPH
- Pharmacist
- Staten Island, NY
National Provider Identifier
1700118486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 027362
- Practice address
- 173 Broad Street
Staten Island, NY 10304-2057 - Phone
- (718) 447-4127
- NPI assigned
- Feb 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 | 027362 | NY | Primary |
Addresses
Primary practice location
173 Broad Street
Staten Island, NY 10304-2057
Mailing address
173 Broad Street
Miller Pharmacy
Staten Island, NY 10304-2057
Phone (718) 447-4127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00745331 | Medicaid | NY |
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 027362 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sai RX Mart LLC | Past | Accepting new patients | |
| E T Drugs Inc | 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.
-
- Community/Retail Pharmacy
- Staten Island, NY
- NPI 1376655381
-
- Community/Retail Pharmacy
- Staten Island, NY
- NPI 1609327113
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265328000000",
"number": "1700118486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "173 BROAD STREET",
"address_2": "MILLER PHARMACY",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103042057",
"telephone_number": "718-447-4127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "173 BROAD STREET",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103042057",
"telephone_number": "718-447-4127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ASEDO",
"first_name": "ETHAN",
"middle_name": "SIMON",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-05",
"last_updated": "2010-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "027362",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00745331",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.