1013107267 NPI number — VILLAGE SUPER MARKET OF NJ LP

Table of content: DR. DAVID ROY GABRIEL O.D. (NPI 1093714107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013107267 NPI number — VILLAGE SUPER MARKET OF NJ LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE SUPER MARKET OF NJ LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013107267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 MOUNTAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-404-4160
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 SOUTH PITNEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08205-9780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-404-4160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIGUEROA RIVERA
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
THIRD PARTY ADMINISTRATOR
Authorized Official Telephone Number:
732-521-8439

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)