Provider Demographics
NPI:1700047719
Name:PRUDENTIAL HEALTHCARE
Entity Type:Organization
Organization Name:PRUDENTIAL HEALTHCARE
Other - Org Name:PINTO'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-653-3154
Mailing Address - Street 1:161 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1146
Mailing Address - Country:US
Mailing Address - Phone:201-653-3154
Mailing Address - Fax:201-653-7576
Practice Address - Street 1:161 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1146
Practice Address - Country:US
Practice Address - Phone:201-653-3154
Practice Address - Fax:201-653-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X, 3336M0003X, 3336S0011X, 332B00000X, 3336M0003X
NJ28RS00707500333600000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134634OtherPK