Healthcare Provider Details

I. General information

NPI: 1326640806
Provider Name (Legal Business Name): HACKENSACK SURGERY AND WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUMMIT AVE STE 105
HACKENSACK NJ
07601-1271
US

IV. Provider business mailing address

5 SUMMIT AVE STE 105
HACKENSACK NJ
07601-1271
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2900
  • Fax:
Mailing address:
  • Phone: 551-996-2900
  • Fax: 201-883-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: SARASWATI D DAYAL
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 551-996-2900