Active NPI
Justin Im
- Pharmacist
- Oceanside, NY
National Provider Identifier
1821689977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 067376
- Practice address
- 1 Healthy Way
Oceanside, NY 11572-1551 - Phone
- (516) 632-3000
- NPI assigned
- Feb 1, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 067376 | NY | Primary |
Addresses
Primary practice location
1 Healthy Way
Oceanside, NY 11572-1551
Mailing address
197-05A 65TH Crescent Apt 2a
Fresh Meadows, NY 11365
Phone (718) 755-5329
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 067376 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612137600000",
"number": "1821689977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "197-05A 65TH CRESCENT APT 2A",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "11365",
"telephone_number": "718-755-5329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HEALTHY WAY",
"city": "OCEANSIDE",
"state": "NY",
"postal_code": "115721551",
"telephone_number": "516-632-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-01",
"last_updated": "2021-02-01",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "067376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, NY
- Icahn School of Medicine at Mount Sinai
- Icahn School of Medicine at Mount Sinai
- Icahn School of Medicine at Mount Sinai
- Icahn School of Medicine at Mount Sinai
- Icahn School of Medicine at Mount Sinai
- Afm Ashik Imran, DO
- Infused Health and Wellness
- Insured Medical Supply Inc.
- Integrated Telehealth Medicine PC
- Scott Ippolito, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.