NPIMap

Organization Active NPI

Healthsource Pharmacy Inc

Doing business as Healthsource Pharmacy

  • Community/Retail Pharmacy
  • New York, NY
National Provider Identifier
1770695876
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
025135 Issued in NY
Legal business name
HEALTHSOURCE PHARMACY INC
Doing business as
Healthsource Pharmacy
Practice address
1296 2ND Ave
New York, NY 10065-5707
Phone
(212) 794-8700
Fax
(212) 794-4979
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Authorized official

Name
Boris NiyazovNPI 1497928345
Title
President
Phone
(212) 794-8700

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 025135 NY Primary

Addresses

Primary practice location

1296 2ND Ave
New York, NY 10065-5707

Mailing address

1302 2ND Ave
New York, NY 10065-5706
Phone (212) 794-8700

Other identifiers 2

IdentifierTypeStateIssuer
02182694MedicaidNY
2063440OtherPK

Other names 1

  • HEALTHSOURCE PHARMACY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL pharmacist@healthsourcepharmacy.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930068889 NY DME Supplier - Pharmacy 7719190313 Practice locations: New York, NY
O20200625002071 NY Part B Supplier - Pharmacy 7719190313 Practice locations: New York, NY

National Provider Directory

National Provider Directory

Locations

1302 2nd Ave
New York, NY 10065
Phone (212) 481-6600

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1770695876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100655706",
            "telephone_number": "212-794-8700",
            "fax_number": "212-794-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100655707",
            "telephone_number": "212-794-8700",
            "fax_number": "212-794-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "NIYAZOV",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-794-8700"
    },
    "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": "025135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02182694",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2063440",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "pharmacist@healthsourcepharmacy.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1296 2nd Ave",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100655707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "HEALTHSOURCE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HEALTHSOURCE 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 Apr 27, 2022; 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.