1720456478 NPI number — STOP AND SHOP SUPERMARKET CO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720456478 NPI number — STOP AND SHOP SUPERMARKET CO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOP AND SHOP SUPERMARKET CO 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:
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:
1720456478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1149 HARRISBURG PIKE
Provider Second Line Business Mailing Address:
ATTN: APRIL HOOVER
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-960-8553
Provider Business Mailing Address Fax Number:
717-960-1389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 VALLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07079-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-762-5044
Provider Business Practice Location Address Fax Number:
973-378-3449
Provider Enumeration Date:
09/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCCALL
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP HEALTH & HOUSEHOLD
Authorized Official Telephone Number:
717-960-5666

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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