1396821583 NPI number — RIVAS MEDICAL SUPPLIES LLC

Table of content: (NPI 1396821583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396821583 NPI number — RIVAS MEDICAL SUPPLIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVAS MEDICAL SUPPLIES LLC
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:
RIVAS MEDICAL SUPPLIES LLC
Provider Other Organization Name Type Code:
4
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:
1396821583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 RUTGERS UNIVERSITY BLVD STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-249-8989
Provider Business Mailing Address Fax Number:
732-657-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 RUTGERS UNIVERSITY BLVD STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08701-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-249-8989
Provider Business Practice Location Address Fax Number:
732-657-9400
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERMAN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-249-8989

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010003142-01 . This is a "AMERICHOICE OF NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 29560 . This is a "UNIVERSITY HEALTHPLAN OF NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 43ZA00019700 . This is a "RESPIRATORY THERAPIST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A2403335 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2507716 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 38627 . This is a "IDA INSURANCE COMPANY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8520607 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2059451 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CFORM0569 . This is a "CERTIFIED ORTHOTIC & MASTECTOMY FITTER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 28RW01086500 . This is a "CERTIFIED PHARMACY TECHNICIAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 88349 . This is a "AMERIGROUP OF NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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