MEDICARE: EJ AND JJ INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	28RS00534000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	45PD00000700	OTHER	NJ	ORTHOTICS & PROSTHETICS( PEDORTHIST)

General Provider Information

NPI Number	:	1467490177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJ AND JJ INC

Provider Business Mailing Address
First Line	:	2468 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6206
Country	:	US
Telephone Number	:	201-944-1002
Fax Number	:	201-944-6336

Provider Business Practice Location Address
First Line	:	2468 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6206
Country	:	US
Telephone Number	:	201-944-1002
Fax Number	:	201-944-6336

Authorized Official
Title or Position	:	PHARMACIST PRESIDENT
Name	:	MR. JAMES JISUK JUNG
Credential	:	R.PH.
Telephone Number	:	201-944-1002

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/29/2014

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