1710267059 NPI number — S & V SERVICES OF NJ, INC

Table of content: (NPI 1710267059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710267059 NPI number — S & V SERVICES OF NJ, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & V SERVICES OF NJ, INC
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:
MEADOWLANDS PARKWAY PHARMACY
Provider Other Organization Name Type Code:
3
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:
1710267059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 MEADOWLANDS PARKWAY PHARMACY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SECAUCUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-325-6700
Provider Business Mailing Address Fax Number:
201-392-3544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 MEADOWLANDS PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SECAUCUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-235-6700
Provider Business Practice Location Address Fax Number:
201-392-3544
Provider Enumeration Date:
08/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARQUIS
Authorized Official First Name:
IRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-325-6700

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RS00714900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0294888 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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