1629183405 NPI number — SAKER SHOPRITE'S INC

Table of content: (NPI 1629183405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629183405 NPI number — SAKER SHOPRITE'S INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAKER SHOPRITE'S 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:
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:
1629183405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
922 HIGHWAY 33
Provider Second Line Business Mailing Address:
BUILDING 6
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-8439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3166 US HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANCHBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08876-3430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-704-2153
Provider Business Practice Location Address Fax Number:
908-704-2155
Provider Enumeration Date:
08/20/2006

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:
732-521-8448

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  RS026954 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3142003 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8169811 . This is a "MEDICAID DME" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8169802 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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