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Pathmark Stores Inc

Pharmacy in Port Jefferson Station, NY · enumerated 2006 · authorized official Susan Kijowski, Manager, Regulatory Compliance.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1962509737

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Registry record

Entity type Organization (Type 2)
Legal business name Pathmark Stores Inc
Other name <Unavail>
Parent organization Great Atlantic & Pacific Tea Co., Inc, the.
Practice address 5145 Nesconset Hwy, Port Jefferson Station, NY, 11776
Phone (631) 331-2210
Fax (631) 473-3291
Enumeration date Sep 20, 2006
Last updated in NPPES Aug 16, 2013

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers · License 016040 (NY) Secondary
333600000X Pharmacy Suppliers · License 016040 (NY) Primary
3336C0003X Community/Retail Pharmacy Suppliers Secondary

Authorized official

Name Susan Kijowski
Title Manager, Regulatory Compliance
Phone (201) 571-8326

Other identifiers

Identifier Type State Issuer
00490111 Medicaid NY -
3364229 Other - OTHER ID NUMBER-COMMERCIAL NUMBER

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2013-08-16. Verify at npiregistry.cms.hhs.gov.
Where is Pathmark Stores Inc located?
The practice location on file with NPPES is in Port Jefferson Station, NY.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2013-08-16.