Organization
INSERRA SUPERMARKET INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8448
Entity
Organization
Contact information
Practice address
900 MADISON ST, HOBOKEN, NJ 07030-6483
(201) 792-9652
(201) 792-6241
Mailing address
PO BOX 8500-51250, PHILADELPHIA, PA 19178-0001
(201) 792-9652
(201) 792-6241
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016837
—
NJ
01
—
0016845
MEDICAID DME
NJ
01
—
3145528
NCPDP
NJ
Enumeration date
02/02/2007
Last updated
08/03/2011
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