1821013384 NPI number — GREAT ATLANTIC & PACIFIC TEA COMPANY INC

Table of content: (NPI 1821013384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821013384 NPI number — GREAT ATLANTIC & PACIFIC TEA COMPANY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT ATLANTIC & PACIFIC TEA COMPANY 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:
1821013384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6369
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:
3105 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOHEGAN LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10547-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-526-0240
Provider Business Practice Location Address Fax Number:
914-526-0244
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIJOWSKI
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, REGULATORY COMPLIANCE
Authorized Official Telephone Number:
201-571-8326

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 023501 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 023501 , 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: 01815627 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018156270442 . This is a "MEDICAID DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3332741 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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