NPIMap

Organization Active NPI

Union Avenue Healthcare Inc

Doing business as Union Avenue Legend Pharmacy

  • Community/Retail Pharmacy
  • Bound Brook, NJ
National Provider Identifier
1700807773
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
28RS00584200 Issued in NJ
Legal business name
UNION AVENUE HEALTHCARE INC
Doing business as
Union Avenue Legend Pharmacy
Practice address
433 W Union Ave
Bound Brook, NJ 08805-1220
Phone
(732) 356-3113
Fax
(732) 356-6691
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Authorized official

Name
Jatin PatelNPI 1396338307
Title
Owner
Phone
(732) 356-3113

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 28RS00584200 NJ Primary

Addresses

Primary practice location

433 W Union Ave
Bound Brook, NJ 08805-1220

Mailing address

433 W Union Ave
Bound Brook, NJ 08805-1220
Phone (732) 356-3113

Other identifiers 2

IdentifierTypeStateIssuer
2054957OtherPK
8385301MedicaidNJ

Other names 1

  • UNION AVENUE LEGEND PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930091387 NJ DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 4880706969 Practice locations: Bound Brook, NJ
O20120110000640 NJ Part B Supplier - Mass Immunization (Roster Biller Only) 4880706969 Practice locations: Bound Brook, NJ

National Provider Directory

National Provider Directory
Tax ID family
Union Avenue Healthcare Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1700807773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 W UNION AVE",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051220",
            "telephone_number": "732-356-3113",
            "fax_number": "732-356-6691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 W UNION AVE",
            "city": "BOUND BROOK",
            "state": "NJ",
            "postal_code": "088051220",
            "telephone_number": "732-356-3113",
            "fax_number": "732-356-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNION AVENUE HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "JATIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-356-3113"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00584200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2054957",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8385301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNION AVENUE LEGEND PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bound Brook, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.