NPIMap

Organization Active NPI

Stop & Shop Supermarket Company LLC

  • Community/Retail Pharmacy
  • Shirley, NY
National Provider Identifier
1962685909
Registry record updated Dec 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
STOP & SHOP SUPERMARKET COMPANY LLC
Practice address
999 Montauk Hwy
Shirley, NY 11967-2130
Phone
(631) 281-3610
Fax
(631) 281-8924
NPI assigned
Dec 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2017

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

Authorized official

Name
Brad Dayton
Title
Director Pharmacy Systems
Phone
(617) 770-8782

Specialties & licenses 2

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

Addresses

Primary practice location

999 Montauk Hwy
Shirley, NY 11967-2130

Mailing address

999 Montauk Hwy
Shirley, NY 11967-2130
Phone (631) 281-3610

Other identifiers 2

IdentifierTypeStateIssuer
3357084OtherNYNCPDP
02949237MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080912000121 TX Part B Supplier - Centralized Flu Biller 5698841864 This NPI is an additional NPI on the enrollment
O20100930023546 NY DME Supplier - PharmacyDME Supplier - Grocery Store 5698841864 Practice locations: Shirley, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stop & Shop Supermarket Company LLC999 Montauk Hwy, Shirley, NY 11967-2130(631) 281-8924 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Ostomy Supplies|Urological Supplies|Surgical Dressings Accepts assignmentParticipating since Sep 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
Stop Shop Pharmacy 434214 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514419200000",
    "number": "1962685909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 MONTAUK HWY",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119672130",
            "telephone_number": "631-281-3610",
            "fax_number": "631-281-8924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 MONTAUK HWY",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119672130",
            "telephone_number": "631-281-3610",
            "fax_number": "631-281-8924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP & SHOP SUPERMARKET COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2017-12-28",
        "status": "A",
        "authorized_official_last_name": "DAYTON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "DIRECTOR PHARMACY SYSTEMS",
        "authorized_official_telephone_number": "617-770-8782"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3357084",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02949237",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shirley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.