NPIMap

Organization Active NPI

Waldbaum Inc

  • Pharmacy
  • Staten Island, NY
National Provider Identifier
1831114396
Registry record updated Nov 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
025266 Issued in NY
Legal business name
WALDBAUM INC
Practice address
4343 Amboy Rd
Staten Island, NY 10312-3819
Phone
(718) 984-6073
Fax
(718) 984-5634
NPI assigned
Jul 13, 2006
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2007

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

Authorized official

Name
Susan Kijowski
Title
Pharmacy Specialist
Phone
(201) 571-8326

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 025266 NY
Pharmacy 333600000X 025266 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

4343 Amboy Rd
Staten Island, NY 10312-3819

Mailing address

4343 Amboy Rd
Staten Island, NY 10312-3819

Other identifiers 3

IdentifierTypeStateIssuer
022481990442OtherNYMEDICAID DME
02248199MedicaidNY
3324174OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • WALDBAUMS PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Waldbaum Inc7 organizations share this tax ID, including this one
Part of
Great Atlantic Pacific Tea Company Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4343 Amboy Rd
Staten Island, NY 10312
Phone (718) 984-6073

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194566400000",
    "number": "1831114396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 AMBOY RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 AMBOY RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123819",
            "telephone_number": "718-984-6073",
            "fax_number": "718-984-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDBAUM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-09",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PHARMACY SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "025266",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "025266",
            "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": "MEDICAID DME",
            "identifier": "022481990442",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02248199",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3324174",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDBAUMS PHARMACY",
            "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 Nov 9, 2007; 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.