Provider Demographics
NPI:1871570853
Name:GRISTEDES OPERATING CORP
Entity type:Organization
Organization Name:GRISTEDES OPERATING CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-217-2789
Mailing Address - Street 1:460 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6027
Mailing Address - Country:US
Mailing Address - Phone:212-251-0052
Mailing Address - Fax:212-251-0058
Practice Address - Street 1:460 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6027
Practice Address - Country:US
Practice Address - Phone:212-251-0052
Practice Address - Fax:212-251-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02023467Medicaid
BG6383385OtherD&A
3347829OtherNCPDP
1312720002Medicare ID - Type Unspecified