NPIMap

Organization Active NPI

Inserra Supermarket Incorporated

  • Pharmacy
  • Emerson, NJ
National Provider Identifier
1679688444
Registry record updated Aug 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
RS003194 Issued in NJ
Legal business name
INSERRA SUPERMARKET INCORPORATED
Practice address
425 Old Hook Rd
Emerson, NJ 07630-1323
Phone
(201) 262-1722
Fax
(201) 262-4212
NPI assigned
Aug 20, 2006
Last updated
Aug 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Figueroa Rivera
Title
Third Party Administrator
Phone
(732) 521-8448

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X RS003194 NJ Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

425 Old Hook Rd
Emerson, NJ 07630-1323

Mailing address

425 Old Hook Rd
Emerson, NJ 07630-1323

Other identifiers 3

IdentifierTypeStateIssuer
4336011OtherNJMEDICAID DME
3123774OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4336003MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111013000093 NJ Part B Supplier - Mass Immunization (Roster Biller Only) 9436276185 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Emerson, NJ; Hillsdale, NJ; Hoboken, NJ; Jersey City, NJ; Lodi, NJ; Lyndhurst, NJ; New Milford, NJ; Northvale, NJ…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282089600000",
    "number": "1679688444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 OLD HOOK RD",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 OLD HOOK RD",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301323",
            "telephone_number": "201-262-1722",
            "fax_number": "201-262-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSERRA SUPERMARKET INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2010-08-18",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA RIVERA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "732-521-8448"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "RS003194",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "4336011",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3123774",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4336003",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Emerson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.