1396777249 NPI number — STOP AND SHOP SUPERMARKET CO LLC

Table of content: (NPI 1396777249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396777249 NPI number — STOP AND SHOP SUPERMARKET CO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOP AND SHOP SUPERMARKET CO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STOP AND SHOP PHARMACY 802
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396777249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 ROUTE 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 ROUTE 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-422-4425
Provider Business Practice Location Address Fax Number:
732-422-4427
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAYTON
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
617-770-8782

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  28RS00594300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 28RS00594300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RS00594300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3142926 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8455201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com