Organization
INSERRA SUPERMARKETS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
400 MARIN BLVD, JERSEY CITY, NJ 07302-2546
(201) 418-0327
(201) 418-7370
Mailing address
400 MARIN BLVD, JERSEY CITY, NJ 07302-2546
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RS005109
NJ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252409
—
NJ
01
—
0252697
MEDICAID DME
NJ
01
—
3136670
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
02/16/2011
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