Provider Demographics
NPI:1538233960
Name:JR & FDP ENTERPRISES INC
Entity type:Organization
Organization Name:JR & FDP ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEPHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-677-2912
Mailing Address - Street 1:50 S CENTER ST
Mailing Address - Street 2:UNIT 16
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3529
Mailing Address - Country:US
Mailing Address - Phone:973-677-2912
Mailing Address - Fax:973-677-2913
Practice Address - Street 1:50 S CENTER ST
Practice Address - Street 2:UNIT 16
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3529
Practice Address - Country:US
Practice Address - Phone:973-677-2912
Practice Address - Fax:973-677-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0110604Medicaid
NJ1020206OtherHORIZON NJ HEALTH
NJ0110604Medicaid