Active NPI
Pathmark Stores, Inc.
- Pharmacy
- Staten Island, NY
National Provider Identifier
1861623407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 029643
- Legal business name
- PATHMARK STORES, INC.
- Practice address
- 2660 Hylan Blvd
Staten Island, NY 10306-4355 - Phone
- (718) 668-2972
- Fax
- (718) 668-2974
- NPI assigned
- Jul 30, 2009
- Organization subpart
- Yes
- Parent organization
- THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan D Kijowski
- Title
- Pharmacy Specialist
- Phone
- (201) 571-8326
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 029643 | NY | |
| Pharmacy | 333600000X | 029643 | NY | Primary |
Addresses
Primary practice location
2660 Hylan Blvd
Staten Island, NY 10306-4355
Mailing address
2 Paragon Dr
Montvale, NJ 07645-1718
Phone (201) 573-9700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029643 | Other | NY | STATE LICENSE |
Other names 1
- PATHMARK PHARMACY # 171
National Provider Directory
National Provider Directory- Part of
- Great Atlantic Pacific Tea Company Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248912000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1861623407",
"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": "2660 HYLAN BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103064355",
"telephone_number": "718-668-2972",
"fax_number": "718-668-2974"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PATHMARK STORES, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA CO., INC.",
"enumeration_date": "2009-07-30",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "KIJOWSKI",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "D",
"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": "029643",
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NY",
"license": "029643",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "029643",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PATHMARK PHARMACY # 171",
"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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.