Provider Demographics
NPI:1629053590
Name:GRISTEDES FOODS INC
Entity Type:Organization
Organization Name:GRISTEDES FOODS INC
Other - Org Name:GRISTEDES PHARMACY 514
Other - Org Type:Doing Business As
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 1:1344 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4404
Mailing Address - Country:US
Mailing Address - Phone:212-879-9050
Mailing Address - Fax:212-879-1477
Practice Address - Street 1:1344 FIRST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4404
Practice Address - Country:US
Practice Address - Phone:212-879-9050
Practice Address - Fax:212-879-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025026333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3318955OtherNCPDP
NY02415878Medicaid
NY02415878Medicaid