Provider Demographics
NPI:1326181348
Name:VILLAGE SUPER MARKET OF NJ LP
Entity Type:Organization
Organization Name:VILLAGE SUPER MARKET OF NJ LP
Other - Org Name:SHOPRITE PHARMACY OF HILLSBOROUGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-521-8439
Mailing Address - Street 1:733 MOUNTAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:908-359-7419
Mailing Address - Fax:908-359-8671
Practice Address - Street 1:601 RT 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1521
Practice Address - Country:US
Practice Address - Phone:908-359-7419
Practice Address - Fax:908-359-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS0035833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3126643OtherNCPDP
NJ4359305Medicaid
NJ1309060017Medicare NSC