Provider Demographics
NPI:1114025145
Name:BELZOLLC
Entity Type:Organization
Organization Name:BELZOLLC
Other - Org Name:ROCKAWAY PHARMACY AND COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-625-8558
Mailing Address - Street 1:25 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3435
Mailing Address - Country:US
Mailing Address - Phone:973-625-8558
Mailing Address - Fax:973-625-5095
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3435
Practice Address - Country:US
Practice Address - Phone:973-625-8558
Practice Address - Fax:973-625-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004777003336C0003X, 3336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148225OtherPK
2148225OtherPK
1318610001Medicare NSC