Provider Demographics
NPI:1821138025
Name:VILLAGE SUPER MARKET OF NJ LP
Entity Type:Organization
Organization Name:VILLAGE SUPER MARKET OF NJ LP
Other - Org Name:SHOPRITE PHARMACY OF CHATHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
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 1:641 SHUNPIKE RD
Mailing Address - Street 2:SOUTHERN BLVD
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:973-377-5770
Mailing Address - Fax:973-377-0676
Practice Address - Street 1:641 SHUNPIKE RD/SOUTHERN BLVD
Practice Address - Street 2:SOUTHERN BLVD
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1567
Practice Address - Country:US
Practice Address - Phone:973-377-5770
Practice Address - Fax:973-377-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS0040053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4389107Medicaid
NJ3129132OtherNCPDP
NJ1309060010Medicare NSC