Provider Demographics
NPI:1841209731
Name:ST CLARA MEDICAL SUPPLIES CORP
Entity Type:Organization
Organization Name:ST CLARA MEDICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:201-863-2424
Mailing Address - Street 1:125 48TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6454
Mailing Address - Country:US
Mailing Address - Phone:201-863-2424
Mailing Address - Fax:201-863-8585
Practice Address - Street 1:125 48TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6454
Practice Address - Country:US
Practice Address - Phone:201-863-2424
Practice Address - Fax:201-863-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7813406Medicaid
NJ5397360001Medicare NSC