Provider Demographics
NPI:1366586828
Name:GLEN ROCK HEALTH CARE ENTERPRISES INC.
Entity type:Organization
Organization Name:GLEN ROCK HEALTH CARE ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-689-2252
Mailing Address - Street 1:644 GODWIN AVE. #2 GODWIN PLAZA
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1450
Mailing Address - Country:US
Mailing Address - Phone:201-689-2252
Mailing Address - Fax:
Practice Address - Street 1:644 GODWIN AVE. #2 GODWIN PLAZA
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1450
Practice Address - Country:US
Practice Address - Phone:201-689-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005886003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8374805Medicaid
4148300001Medicare ID - Type Unspecified