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General NPI Number Information
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NPI Number | 1740395524
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Entity Type | Organization
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Legal Business Name | VILLAGE SUPER MARKET OF NJ LP
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 93 MORRISTOWN RD RT 202
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2337
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Country | US
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Telephone | 908-766-4409
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Fax |
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Provider Business Mailing Address
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Address Line | 733 MOUNTAIN AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-3223
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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 | THIRD PARTY ADMINISTRATOR
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Name | MELISSA FIGUEROA RIVERA
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Credential |
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Telephone | 732-521-8448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RS004637
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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