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
540 YORK AVE DELAFIELD RD, LYNDHURST, NJ 07071
(201) 978-4543
(201) 372-0695
Mailing address
PO BOX 8500-51250, PHILADELPHIA, PA 19178-0001
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RS004301
NJ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3131187
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4410700
—
NJ
01
—
4410718
MEDICAID DME
NJ
Enumeration date
08/20/2006
Last updated
08/18/2010
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