Active NPI
Prasad Varghese Thaivalappil
- Pharmacist
- Jackson Heights, NY
National Provider Identifier
1730834375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 068840
- Practice address
- 8911 Northern Blvd
Jackson Heights, NY 11372-1674 - Phone
- (718) 426-2508
- NPI assigned
- Feb 12, 2022
- Last updated
- Feb 12, 2022
- Sex
- Male
- 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 | 068840 | NY | Primary |
Addresses
Primary practice location
8911 Northern Blvd
Jackson Heights, NY 11372-1674
Mailing address
52 Stuart Dr
Syosset, NY 11791-5126
Phone (732) 486-5143
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 |
|---|---|---|---|
| 068840 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644624000000",
"number": "1730834375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 STUART DR",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117915126",
"telephone_number": "732-486-5143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8911 NORTHERN BLVD",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113721674",
"telephone_number": "718-426-2508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THAIVALAPPIL",
"first_name": "PRASAD",
"middle_name": "VARGHESE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-12",
"last_updated": "2022-02-12",
"certification_date": "2022-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "068840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.