Healthcare Provider Details

I. General information

NPI: 1831968007
Provider Name (Legal Business Name): HACKENSACK MERIDIAN AMBULATORY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 OAK TREE RD
EDISON NJ
08820-2012
US

IV. Provider business mailing address

2048 OAK TREE RD
EDISON NJ
08820-2012
US

V. Phone/Fax

Practice location:
  • Phone: 732-906-2100
  • Fax:
Mailing address:
  • Phone: 732-906-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4484100
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: RICHARD HAND
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 732-481-8529