NPIMap

Organization Active NPI

Healthsource Pharmacy III B Inc

  • Community/Retail Pharmacy
  • New York, NY
National Provider Identifier
1962792176
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
030612 Issued in NY
Legal business name
HEALTHSOURCE PHARMACY III B INC
Doing business as
HealthSource Pharmacy
Practice address
1000 1St Ave
At 55TH Street
New York, NY 10022-4105
Phone
(212) 310-0111
Fax
(212) 310-0144
NPI assigned
Apr 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Authorized official

Name
Boris Niyazov
Title
President
Phone
(212) 310-0111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 030612 NY Primary

Addresses

Primary practice location

1000 1St Ave
At 55TH Street
New York, NY 10022-4105

Mailing address

1000 1St Ave
At 55TH Street
New York, NY 10022-4105
Phone (212) 310-0111

Other identifiers 2

IdentifierTypeStateIssuer
3111442MedicaidNY
2129913OtherPK

Other names 1

  • HealthSource Pharmacy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1302393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1962792176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 1ST AVE",
            "address_2": "AT 55TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100224105",
            "telephone_number": "212-310-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 1ST AVE",
            "address_2": "AT 55TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100224105",
            "telephone_number": "212-310-0111",
            "fax_number": "212-310-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE PHARMACY III B INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-10",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "NIYAZOV",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-310-0111"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3111442",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2129913",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.