Organization Active NPI

Justin Pharmacy Inc

  • Community/Retail Pharmacy
  • New York, NY
National Provider Identifier
1770693236
Registry record updated Dec 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
026695 Issued in NY
Legal business name
JUSTIN PHARMACY INC
Practice address
3860 Broadway
New York, NY 10032-1545
Phone
(212) 923-6111
Fax
(212) 923-2882
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2016

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

Authorized official

Name
Binu BabyNPI 1619121449
Title
Pres
Phone
(212) 923-6111

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 026695 NY Primary

Addresses

Primary practice location

3860 Broadway
New York, NY 10032-1545

Mailing address

3860 Broadway
New York, NY 10032-1545
Phone (212) 923-6111

Other identifiers 2

IdentifierTypeStateIssuer
2063266OtherPK
02510589MedicaidNY

Other names 1

  • ST. ANTHONY PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930042754 NY DME Supplier - Pharmacy 0648488767 Practice locations: New York, NY
O20220112002484 NY Part B Supplier - Mass Immunization (Roster Biller Only) 0648488767 Practice locations: New York, NY

National Provider Directory

National Provider Directory

Locations

3860 Broadway
New York, NY 10032
Phone (212) 923-6111

Practitioners & affiliated clinicians

Practitioners 3

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482019200000",
    "number": "1770693236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321545",
            "telephone_number": "212-923-6111",
            "fax_number": "212-923-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321545",
            "telephone_number": "212-923-6111",
            "fax_number": "212-923-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-12-18",
        "status": "A",
        "authorized_official_last_name": "BABY",
        "authorized_official_first_name": "BINU",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "212-923-6111"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "026695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2063266",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02510589",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. ANTHONY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2016; 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.