Pathmark Stores Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

28RS00293600 Issued in NJ

Legal business name

PATHMARK STORES INC

Doing business as

Pathmark Pharmacy #580

Practice address

1600 Saint Georges Ave
Avenel, NJ 07001-1044

Phone

(732) 499-7904

Fax

(732) 943-1479

NPI assigned

Sep 20, 2006

Organization subpart

Yes

Parent organization

THE GREAT ATLANTIC & PACIFIC TEA COMPANYAs reported in NPPES

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

Authorized official

Name

Susan D Kijowski

Title

Manager, Regulatory Compliance

Phone

(201) 571-8326

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PATHMARK PHARMACY #580 Doing business as

Part of

Great Atlantic Pacific Tea Company Inc

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381449600000",
    "number": "1811094675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416369",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416369",
            "telephone_number": "201-571-8326",
            "fax_number": "201-571-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SAINT GEORGES AVE",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011044",
            "telephone_number": "732-499-7904",
            "fax_number": "732-943-1479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA COMPANY",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-10-11",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER, REGULATORY COMPLIANCE",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NJ",
            "license": "RS28002936",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "28RS00293600",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4326300",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3122330",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY #580",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gaurang Ramanbhai Patel, M.D.
• Kajal Patel
• Melvina Patel
• Misri Malav Patel
• Ruchi Patel
• Paul Pyo MD LLC
• Paul Saks DPM,PA
• Michelle Paxton
• Pennreach
• Marc Lee Pereira

• Pharmacy in Avenel, NJ
• Providers in Avenel, NJ by specialty
• Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.