Provider Demographics
NPI:1518150598
Name:GREEN VALLEY MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:GREEN VALLEY MEDICAL EQUIPMENT
Other - Org Name:GREEN VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BELGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-469-1909
Mailing Address - Street 1:214 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-2026
Mailing Address - Country:US
Mailing Address - Phone:732-469-1909
Mailing Address - Fax:908-688-5871
Practice Address - Street 1:214 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-2026
Practice Address - Country:US
Practice Address - Phone:732-469-1909
Practice Address - Fax:908-688-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00597500332000000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3139513Medicare PIN