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General NPI Number Information
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NPI Number | 1598865529
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Entity Type | Organization
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Legal Business Name | GREAT ATLANTIC & PACIFIC TEA COMPANY INC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 460 COUNTY LINE ROAD & RTE. 520 EAST
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City | MARLBORO
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State | NJ
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Zip | 07746-1041
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Country | US
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Telephone | 732-834-0925
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Fax | 732-834-0927
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Provider Business Mailing Address
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Address Line | PO BOX 416369
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City | BOSTON
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State | MA
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Zip | 02241-6369
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER, REGULATORY COMPLIANCE
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Name | SUSAN D KIJOWSKI
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Credential |
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Telephone | 201-571-8326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 28RS00331300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00331300
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License Number State | NJ
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