Healthcare Provider Details

I. General information

NPI: 1235192675
Provider Name (Legal Business Name): HACKENSACK ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PROPECT AVE SUITE 10
HACKENSACK NJ
07601-1820
US

IV. Provider business mailing address

170 PROPECT AVE SUITE 10
HACKENSACK NJ
07601-1820
US

V. Phone/Fax

Practice location:
  • Phone: 201-498-0030
  • Fax: 201-708-6300
Mailing address:
  • Phone: 201-498-0030
  • Fax: 201-708-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23065
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. JOAN MARIE BALDUCCI
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 201-498-0030