Provider Demographics
NPI:1083884928
Name:PATHMARK STORES, INC.
Entity Type:Organization
Organization Name:PATHMARK STORES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:LA
Authorized Official - Last Name:PINTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-586-4317
Mailing Address - Street 1:16417 GRAND CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16417 GRAND CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1810
Practice Address - Country:US
Practice Address - Phone:718-591-0978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY45701282E00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No282E00000XHospitalsLong Term Care Hospital