Healthcare Provider Details

I. General information

NPI: 1255363107
Provider Name (Legal Business Name): THE STOP & SHOP SUPERMARKET COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARKET ST
NANUET NY
10954-2801
US

IV. Provider business mailing address

101 MARKET ST SUITE E
NANUET NY
10954-2801
US

V. Phone/Fax

Practice location:
  • Phone: 845-624-0659
  • Fax: 845-624-3386
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number24360
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number24360
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24360
License Number StateNY

VIII. Authorized Official

Name: ROGER WHEELER
Title or Position: PRESIDENT
Credential:
Phone: 617-689-4130