Organization Active NPI

Pathmark Stores Inc

Doing business as Pathmark Pharmacy

  • Pharmacy
  • West Babylon, NY
National Provider Identifier
1780781559
Registry record updated Aug 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
016242 Issued in NY
Legal business name
PATHMARK STORES INC
Doing business as
Pathmark Pharmacy
Practice address
531 W Montauk Hwy
West Babylon, NY 11704-8308
Phone
(631) 669-0230
Fax
(631) 669-6730
NPI assigned
Sep 20, 2006
Last updated
Aug 26, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 26, 2010

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

Authorized official

Name
Susan D Kijowski
Title
Regulatory Compliance Specialist
Phone
(201) 571-8326

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 016242 NY
Pharmacy 333600000X 016242 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

531 W Montauk Hwy
West Babylon, NY 11704-8308

Mailing address

2 Paragon Dr
Montvale, NJ 07645-1718
Phone (201) 573-9700

Other identifiers 2

IdentifierTypeStateIssuer
3365752OtherOTHER ID NUMBER-COMMERCIAL NUMBER
00517428MedicaidNY

Other names 1

  • PATHMARK PHARMACY Doing business as

National Provider Directory

National Provider Directory
Part of
Great Atlantic Pacific Tea Company Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1780781559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PARAGON DR",
            "city": "MONTVALE",
            "state": "NJ",
            "postal_code": "076451718",
            "telephone_number": "201-573-9700",
            "fax_number": "201-571-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 W MONTAUK HWY",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117048308",
            "telephone_number": "631-669-0230",
            "fax_number": "631-669-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA CO., INC.",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "REGULATORY COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "016242",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "016242",
            "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": "3365752",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00517428",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Babylon, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.