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NPI Code Detail

MEDICARE: GREAT ATLANTIC & PACIFIC TEA COMPANY INC

MEDICARE: GREAT ATLANTIC & PACIFIC TEA COMPANY INC
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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies05835NJ
3333600000XPharmacy05835NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23142142OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932124591
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT ATLANTIC & PACIFIC TEA COMPANY INC
Provider Business Mailing Address
First Line : PO BOX 416369
Second Line :
City : BOSTON
State : MA
Zip : 02241-6369
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 148 CENTER GROVE RD
Second Line :
City : RANDOLPH
State : NJ
Zip : 07869-1325
Country : US
Telephone Number : 973-442-7985
Fax Number : 973-442-1697
Authorized Official
Title or Position : MANAGER, REGULATORY COMPLIANCE
Name : SUSAN KIJOWSKI
Credential :
Telephone Number : 201-571-8326
Provider Enumeration Date : 07/13/2006
Last Update Date : 10/11/2011

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Directions to “GREAT ATLANTIC & PACIFIC TEA COMPANY INC ” Practice Location

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