Provider Demographics
NPI:1457456311
Name:MEDICAL ARTS PHARMACY INC III
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY INC III
Other - Org Name:HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-369-6918
Mailing Address - Street 1:1825 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2106
Mailing Address - Country:US
Mailing Address - Phone:201-369-6918
Mailing Address - Fax:201-333-1149
Practice Address - Street 1:1825 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2106
Practice Address - Country:US
Practice Address - Phone:201-369-6918
Practice Address - Fax:201-333-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336S0011X
NJ28RS006567003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094757Medicaid
2055475OtherPK
5296620001Medicare NSC