Pathmark Stores Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

024649 Issued in NY

Legal business name

PATHMARK STORES INC

Doing business as

Pathmark Pharmacy

Practice address

1720 Eastchester Rd
Bronx, NY 10461-2322

Phone

(718) 823-6185

Fax

(718) 823-6814

NPI assigned

Sep 20, 2006

Organization subpart

Yes

Parent organization

THE GREAT ATLANTIC & PACIFIC TEA COMPANY INCAs 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

Regulatory Compliance Specialist

Phone

(201) 571-8326

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PATHMARK PHARMACY 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": "1287100800000",
    "number": "1962509729",
    "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": "1720 EASTCHESTER RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612322",
            "telephone_number": "718-823-6185",
            "fax_number": "718-823-6814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA COMPANY INC",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-10-15",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "REGULATORY COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "024649",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "024649",
            "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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3314337",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02066104",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Naveena Pathmakumar, M.D
• Yalini Pathmakumar
• Pathmark Stores Inc (Pathmark Pharmacy)
• Pathmark Stores Inc (Pathmark Pharmacy)
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• Mathew Pathrose, PA
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• Venkatachala Pathy, MD
• Sreenivasa R Patibandla, M.D

• Pharmacy in Bronx, NY
• Providers in Bronx, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.