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
425 OLD HOOK RD, EMERSON, NJ 07630-1323
(201) 262-1722
(201) 262-4212
Mailing address
425 OLD HOOK RD, EMERSON, NJ 07630-1323
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RS003194
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3123774
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4336003
—
NJ
01
—
4336011
MEDICAID DME
NJ
Enumeration date
08/20/2006
Last updated
08/18/2010
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