Provider Demographics
NPI:1912012790
Name:LML SUPERMARKETS INCORPORATED
Entity Type:Organization
Organization Name:LML SUPERMARKETS INCORPORATED
Other - Org Name:
Other - Org Type:
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:732-521-8439
Mailing Address - Street 1:583 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3881
Mailing Address - Country:US
Mailing Address - Phone:201-437-5898
Mailing Address - Fax:
Practice Address - Street 1:583 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3881
Practice Address - Country:US
Practice Address - Phone:201-437-5898
Practice Address - Fax:201-339-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS004970333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0252387Medicaid
NJ0252671OtherMEDICAID DME
3136199OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NJ0252387Medicaid