Provider Demographics
NPI:1598859902
Name:BARON DRUG CO OF HOBOKEN INC
Entity Type:Organization
Organization Name:BARON DRUG CO OF HOBOKEN INC
Other - Org Name:BARON DRUG & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVIGNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-659-8484
Mailing Address - Street 1:416 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4896
Mailing Address - Country:US
Mailing Address - Phone:201-659-8484
Mailing Address - Fax:201-659-3113
Practice Address - Street 1:416 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4896
Practice Address - Country:US
Practice Address - Phone:201-659-8484
Practice Address - Fax:201-659-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NJ28RS004645003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4237307Medicaid
3134789OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0146570001Medicare NSC