=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437210820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATVALS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 05/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2260 JOHN F KENNEDY BLVD
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07304-1462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-432-5205
-----------------------------------------------------
Fax | 201-432-2578
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2260 JOHN F KENNEDY BLVD
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07304-1462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-432-5205
-----------------------------------------------------
Fax | 201-432-2578
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | R.PH IN CHARGE
-----------------------------------------------------
Name | MR. MOHAN MATHEW
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 201-432-5205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RI020106
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------