MEDICARE: VILLAGE SUPER MARKET OF NJ LP

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	333600000X	Pharmacy	RS004055	NJ
2	3336C0003X	Community/Retail Pharmacy

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	3129423	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1588779367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE SUPER MARKET OF NJ LP

Provider Business Mailing Address
First Line	:	733 MOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 ENGLISH CREEK AVE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4863
Country	:	US
Telephone Number	:	609-645-0660
Fax Number	:	609-645-8294

Authorized Official
Title or Position	:	THIRD PARTY ADMINISTRATOR
Name	:	MELISSA FIGUEROA RIVERA
Credential	:
Telephone Number	:	732-521-8448

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	06/25/2025

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Directions to “VILLAGE SUPER MARKET OF NJ LP ” Practice Location

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