CMS-1500 Box 24J / 33a • NPI
1609278308
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
3336C0003X (CMS 58)
Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy
Box 32 Service Location & ZIP+4
139 CENTRE ST, STORE 105, NEW YORK, NY, 10013-4552
✓ 9-Digit EDI 837 ZIP+4 (10013-4552)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1609278308 (139 CENTER PHARMACY, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1609278308)
Medicare Beneficiaries
48
Total Billed Services
104
Distinct CPT/HCPCS Codes
8
Medicare Allowed Total
$13,615.73
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
90480 | Admn sarscov2 vacc 1 dose | 13 |
90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 28 |
91322 | Sarscov2 vac 50 mcg/0.5ml im | 13 |
G0009 | Administration of pneumococcal vaccine | 34 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1609278308 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 139 CENTER PHARMACY, LLC |
| Plain-English Specialty | Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy NUCC Code: 3336C0003X (Pharmacy, Community/Retail Pharmacy) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 139 CENTRE ST, STORE 105, NEW YORK, NY, 10013-4552 |
| Practice Telephone / Fax | Tel: (646) 838-6388 | Fax: (718) 513-2047 |
| Administrative Mailing Address | 139 CENTRE ST, NEW YORK, NY, 10013-4552 |
| Enumeration & Last Sync | Enumerated: 2014-09-24 | CMS Record Updated: 2014-09-24 |
| Authorized Official | TRISTAN LIU (Corporate Officer) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in NEW YORK
🔒 Are you 139 CENTER PHARMACY, LLC? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (3336C0003X)
What Does Taxonomy Code 3336C0003X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0003X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (139 CENTER PHARMACY, LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
3336C0003X — Pharmacy, Community/Retail PharmacyPlain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy | State: NY | License: 033068 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.