MEDICARE: THE STOP & SHOP SUPERMARKET COMPANY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	21878	NY
2	333600000X	Pharmacy	21878	NY
3	3336C0003X	Community/Retail Pharmacy	21878	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3321306	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225060189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STOP & SHOP SUPERMARKET COMPANY, LLC

Provider Business Mailing Address
First Line	:	2450 JERUSALEM AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 JERUSALEM AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1827
Country	:	US
Telephone Number	:	516-826-0057
Fax Number	:	516-826-8037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GORDON REID
Credential	:
Telephone Number	:	301-341-3906

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/28/2024

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