1790823706 NPI number — INSERRA SUPERMARKETS INC.

Table of content: (NPI 1790823706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790823706 NPI number — INSERRA SUPERMARKETS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSERRA SUPERMARKETS 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:
1790823706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-51250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-365-2289
Provider Business Mailing Address Fax Number:
973-365-0925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-365-2289
Provider Business Practice Location Address Fax Number:
973-365-0925
Provider Enumeration Date:
02/02/2007

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:
732-521-8439

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  RS003702 , 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)

  • Identifier: 3127241 . This is a "NCPDP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4366310 . This is a "MEDICAID DME" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4366301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com