NPIMap

Organization Active NPI

Village Super Market of NJ LP

  • Community/Retail Pharmacy
  • Chatham, NJ
National Provider Identifier
1821138025
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RS004005 Issued in NJ
Legal business name
VILLAGE SUPER MARKET OF NJ LP
Practice address
641 Shunpike Rd/Southern Blvd
Southern Blvd
Chatham, NJ 07928-1567
Phone
(973) 377-5770
Fax
(973) 377-0676
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X RS004005 NJ Primary

Addresses

Primary practice location

641 Shunpike Rd/Southern Blvd
Southern Blvd
Chatham, NJ 07928-1567

Mailing address

641 Shunpike Rd
Southern Blvd
Chatham, NJ 07920
Phone (973) 377-5770

Other identifiers 2

IdentifierTypeStateIssuer
4389107MedicaidNJ
3129132OtherNJNCPDP

Other names 1

  • Shoprite Pharmacy of Chatham Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111111000319 NJ Part B Supplier - Mass Immunization (Roster Biller Only) 3779604970 22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Washington, NJ; West Orange, NJ; Vineland, NJ; Union, NJ; Stirling, NJ; Somerset, NJ; Somers Point, NJ; Rio Grande, NJ…

Other NPIs on the same Medicare enrollment 22

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

View all 22

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1821138025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 SHUNPIKE RD",
            "address_2": "SOUTHERN BLVD",
            "city": "CHATHAM",
            "state": "NJ",
            "postal_code": "07920",
            "telephone_number": "973-377-5770",
            "fax_number": "973-377-0676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 SHUNPIKE RD/SOUTHERN BLVD",
            "address_2": "SOUTHERN BLVD",
            "city": "CHATHAM",
            "state": "NJ",
            "postal_code": "079281567",
            "telephone_number": "973-377-5770",
            "fax_number": "973-377-0676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE SUPER MARKET OF NJ LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2011-10-13",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "RS004005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4389107",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3129132",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoprite Pharmacy of Chatham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chatham, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; 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.