Active NPI
Nayyar U Imam, PHARMACIST
- Pharmacist
- Coram, NY
National Provider Identifier
1861650723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 037149
- Practice address
- 3663 Route 112
Ste 1
Coram, NY 11727-4130 - Phone
- (631) 698-7788
- Fax
- (631) 698-0103
- NPI assigned
- May 28, 2008
- Last updated
- Nov 3, 2016
- 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 | 037149 | NY | Primary |
Addresses
Primary practice location
3663 Route 112
Ste 1
Coram, NY 11727-4130
Mailing address
3663 Route 112
Coram, NY 11727-4130
Phone (631) 698-7788
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01742121 | Medicaid | NY |
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 |
|---|---|---|---|
| 037149 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coram Drugs Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478131200000",
"number": "1861650723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3663 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274130",
"telephone_number": "631-698-7788",
"fax_number": "631-698-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3663 ROUTE 112",
"address_2": "STE 1",
"city": "CORAM",
"state": "NY",
"postal_code": "117274130",
"telephone_number": "631-698-7788",
"fax_number": "631-698-0103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMAM",
"first_name": "NAYYAR",
"middle_name": "U",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-28",
"last_updated": "2016-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "037149",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01742121",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.