NPIMap

Organization Active NPI

MLTK LLC

Doing business as Shoprite Pharmacy of Hylan Blvd

  • Community/Retail Pharmacy
  • Staten Island, NY
National Provider Identifier
1790975936
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
028450 Issued in NY
Legal business name
MLTK LLC
Doing business as
Shoprite Pharmacy of Hylan Blvd
Practice address
2424 Hylan Blvd
Staten Island, NY 10306-3117
Phone
(718) 979-0718
Fax
(718) 979-5462
NPI assigned
Jul 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Authorized official

Name
Melissa Figueroa Rivera
Title
Third Party Administrator
Phone
(732) 521-8439

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 028450 NY Primary

Addresses

Primary practice location

2424 Hylan Blvd
Staten Island, NY 10306-3117

Mailing address

PO Box 15169
Newark, NJ 07192-5169
Phone (718) 979-0718

Other identifiers 2

IdentifierTypeStateIssuer
2069367OtherPK
2909479MedicaidNY

Other names 1

  • SHOPRITE PHARMACY OF HYLAN BLVD Doing business as

National Provider Directory

National Provider Directory

Locations

2424 Hylan Blvd
Staten Island, NY 10306
Phone (718) 979-0718

Practitioners & affiliated clinicians

Practitioners 4

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": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1790975936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15169",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071925169",
            "telephone_number": "718-979-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063117",
            "telephone_number": "718-979-0718",
            "fax_number": "718-979-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLTK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA RIVERA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "732-521-8439"
    },
    "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": "028450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2069367",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2909479",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPRITE PHARMACY OF HYLAN BLVD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; 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.