NPIMap

Organization Active NPI

Waldbaum Inc

  • Pharmacy
  • East Patchogue, NY
National Provider Identifier
1992720544
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
020605 Issued in NY
Legal business name
WALDBAUM INC
Practice address
655 Montauk Hwy
East Patchogue, NY 11772
Phone
(631) 758-9216
Fax
(631) 758-5607
NPI assigned
Jul 13, 2006
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Susan Kijowski
Title
Pharmacy Specialist
Phone
(201) 571-8326

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 020605 NY
Pharmacy 333600000X 020605 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

655 Montauk Hwy
East Patchogue, NY 11772

Mailing address

655 Montauk Hwy
East Patchogue, NY 11772

Other identifiers 2

IdentifierTypeStateIssuer
3396163OtherOTHER ID NUMBER-COMMERCIAL NUMBER
01201638MedicaidNY

Other names 1

  • WALDBAUMS PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Waldbaum Inc7 organizations share this tax ID, including this one
Part of
Great Atlantic Pacific Tea Company Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1992720544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 MONTAUK HWY",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "11772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 MONTAUK HWY",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "11772",
            "telephone_number": "631-758-9216",
            "fax_number": "631-758-5607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDBAUM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "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": "020605",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "020605",
            "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": "3396163",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01201638",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDBAUMS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.