Provider Demographics
NPI:1710025838
Name:RONETCO SUPERMARKETS INC
Entity Type:Organization
Organization Name:RONETCO SUPERMARKETS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-521-8448
Mailing Address - Street 1:75 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:NETCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07857-1400
Mailing Address - Country:US
Mailing Address - Phone:973-347-3795
Mailing Address - Fax:973-347-8078
Practice Address - Street 1:75 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:NETCONG
Practice Address - State:NJ
Practice Address - Zip Code:07857-1400
Practice Address - Country:US
Practice Address - Phone:973-347-3795
Practice Address - Fax:973-347-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS004079333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3129524OtherNCPDP
NJ4393104Medicaid
NJ0883800004Medicare NSC