Provider Demographics
NPI:1215041280
Name:JATALA INC
Entity Type:Organization
Organization Name:JATALA INC
Other - Org Name:J T L PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRABULSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-641-7200
Mailing Address - Street 1:191 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1514
Mailing Address - Country:US
Mailing Address - Phone:201-641-7200
Mailing Address - Fax:201-641-2939
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1514
Practice Address - Country:US
Practice Address - Phone:201-641-7200
Practice Address - Fax:201-641-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NJ28RS004997003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6318606Medicaid
2053075OtherPK
NJ0954400001Medicare NSC