Active NPI
Anthony G Bubolo I
- Pharmacist
- Williston PK, NY
National Provider Identifier
1740337955
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Oct 19, 2023.
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 035312
- Practice address
- 370 Hillside Ave
Williston PK, NY 11596-2106 - Phone
- (516) 248-7177
- NPI assigned
- Jan 3, 2007
- Last updated
- Feb 29, 2008
- 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 | 035312 | NY | Primary |
Addresses
Primary practice location
370 Hillside Ave
Williston PK, NY 11596-2106
Mailing address
370 Hillside Ave
Williston PK, NY 11596-2106
Phone (516) 248-7177
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035312 | NY | MD | Pharmacist |
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, 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": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204243200000",
"number": "1740337955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "370 HILLSIDE AVE",
"city": "WILLISTON PK",
"state": "NY",
"postal_code": "115962106",
"telephone_number": "516-248-7177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "370 HILLSIDE AVE",
"city": "WILLISTON PK",
"state": "NY",
"postal_code": "115962106",
"telephone_number": "516-248-7177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUBOLO",
"first_name": "ANTHONY",
"middle_name": "G",
"name_prefix": "Mr.",
"name_suffix": "I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2008-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "035312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williston PK, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.