Provider Demographics
NPI:1720171150
Name:REEMBERTO J MAQUIEIRA
Entity Type:Organization
Organization Name:REEMBERTO J MAQUIEIRA
Other - Org Name:CENTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REEMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAQUIEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-854-1829
Mailing Address - Street 1:335 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5412
Mailing Address - Country:US
Mailing Address - Phone:201-854-1829
Mailing Address - Fax:201-854-6371
Practice Address - Street 1:335 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5412
Practice Address - Country:US
Practice Address - Phone:201-854-1829
Practice Address - Fax:201-854-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS003364003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2057875OtherPK
NJ4345100Medicaid
1270000001Medicare NSC