NPIMap

Organization Active NPI

Vakratunda Inc

Doing business as Bergen Pharmacy Clinton Ave

  • Community/Retail Pharmacy
  • Newark, NJ
National Provider Identifier
1780784967
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RS00639700 Issued in NJ
Legal business name
VAKRATUNDA INC
Doing business as
Bergen Pharmacy Clinton Ave
Practice address
194 Clinton Ave
Newark, NJ 07108-2809
Phone
(973) 273-1100
Fax
(973) 273-1288
NPI assigned
Sep 25, 2006
Last updated
Jul 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

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

Authorized official

Name
Rasik Nagrecha
Title
President
Phone
(973) 273-1100

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X RS00639700 NJ Primary
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

194 Clinton Ave
Newark, NJ 07108-2809

Mailing address

23 Canoe Brook Drive
Livingston, NJ 07039-3815
Phone (973) 273-1100

Other identifiers 3

IdentifierTypeStateIssuer
0039021MedicaidNJ
0039039MedicaidNJ
3146239OtherOTHER ID NUMBER

Other names 1

  • BERGEN PHARMACY CLINTON AVE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930087103 NJ DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 1658580436 Practice locations: Newark, NJ
O20210209000182 NJ Part B Supplier - Pharmacy 1658580436 Practice locations: Newark, NJ

National Provider Directory

National Provider Directory
Tax ID family
Vakratunda Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

194 Clinton Ave
Newark, NJ 07108
Phone (973) 273-1100

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1780784967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 CANOE BROOK DRIVE",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070393815",
            "telephone_number": "973-273-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 CLINTON AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071082809",
            "telephone_number": "973-273-1100",
            "fax_number": "973-273-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAKRATUNDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "NAGRECHA",
        "authorized_official_first_name": "RASIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-273-1100"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "RS00639700",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0039021",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0039039",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3146239",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BERGEN PHARMACY CLINTON AVE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.