1720456478 NPI number — STOP AND SHOP SUPERMARKET CO LLC

Table of content: (NPI 1720456478)

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)





Copyright © 2007-2025 www.npivalidator.com