Healthcare Provider Details

I. General information

NPI: 1316744485
Provider Name (Legal Business Name): HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 719
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

20 PROSPECT AVE STE 719
HACKENSACK NJ
07601-1974
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5002
  • Fax:
Mailing address:
  • Phone: 551-996-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

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