Active NPI
Waldbaum Inc
- Pharmacy
- Huntington, NY
National Provider Identifier
1740205202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 021419
- Legal business name
- WALDBAUM INC
- Practice address
- 60 Wall St
Huntington, NY 11743-2065 - Phone
- (631) 421-0134
- Fax
- (631) 385-7008
- NPI assigned
- Jul 13, 2006
- Organization subpart
- Yes
- Parent organization
- THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Kijowski
- Title
- Pharmacy Specialist
- Phone
- (201) 571-8326
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 021419 | NY | |
| Pharmacy | 333600000X | 021419 | NY | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
60 Wall St
Huntington, NY 11743-2065
Mailing address
60 Wall St
Huntington, NY 11743-2065
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3324415 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 01363900 | Medicaid | NY | |
| 013639000442 | Other | NY | MEDICAID DME |
Other names 1
- WALDBAUMS PHARMACY
National Provider Directory
National Provider Directory- Part of
- Great Atlantic Pacific Tea Company Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1194566400000",
"number": "1740205202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 WALL ST",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117432065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 WALL ST",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117432065",
"telephone_number": "631-421-0134",
"fax_number": "631-385-7008"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALDBAUM INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
"enumeration_date": "2006-07-13",
"last_updated": "2007-11-09",
"status": "A",
"authorized_official_last_name": "KIJOWSKI",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "PHARMACY SPECIALIST",
"authorized_official_telephone_number": "201-571-8326"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NY",
"license": "021419",
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NY",
"license": "021419",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3324415",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01363900",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID DME",
"identifier": "013639000442",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WALDBAUMS PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Huntington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.