1104293125 NPI number — ACME MARKETS INC

Table of content: (NPI 1104293125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104293125 NPI number — ACME MARKETS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACME MARKETS 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:
Provider Other Organization Name Type Code:
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:
1104293125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 CULLERTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60131-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-271-0832
Provider Business Mailing Address Fax Number:
914-271-0993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2005 ALBANY POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROTON ON HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10520-1573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-271-0832
Provider Business Practice Location Address Fax Number:
914-271-0993
Provider Enumeration Date:
08/25/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
DEMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
THIRD PARTY MANAGER
Authorized Official Telephone Number:
208-395-3905

Provider Taxonomy Codes

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

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

  • Identifier: APPLIED FOR . This is a "NCPDP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".