NPIMap

Organization Active NPI

Pathmark Stores Inc

  • Pharmacy
  • Wall Township, NJ
National Provider Identifier
1992802755
Registry record updated Jan 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
RS003959 Issued in NJ
Legal business name
PATHMARK STORES INC
Practice address
1933 State Route 35
Wall Township, NJ 07719-3502
Phone
(732) 449-8070
Fax
(732) 974-2734
NPI assigned
Sep 20, 2006
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2009

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X RS28003959 NJ
Pharmacy 333600000X RS003959 NJ Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1933 State Route 35
Wall Township, NJ 07719-3502

Mailing address

2 Paragon Dr
Montvale, NJ 07645-1718
Phone (201) 571-8326

Other identifiers 2

IdentifierTypeStateIssuer
3128560OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4384300MedicaidNJ

Other names 1

  • PATHMARK PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pathmark Pharmacy10 organizations share this tax ID, including this one
Part of
Great Atlantic Pacific Tea Company Inc

Other organizations with this tax ID 9

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1992802755",
    "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": "201-571-8326",
            "fax_number": "201-573-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 STATE ROUTE 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193502",
            "telephone_number": "732-449-8070",
            "fax_number": "732-974-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA COMPANY",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "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": "NJ",
            "license": "RS28003959",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "RS003959",
            "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": "3128560",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4384300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wall Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; 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.