Healthcare Provider Details

I. General information

NPI: 1972254233
Provider Name (Legal Business Name): HACKENSACK MUSCULOSKELETAL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

40 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

V. Phone/Fax

Practice location:
  • Phone: 551-309-1700
  • Fax:
Mailing address:
  • Phone: 551-309-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
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: JOHN KEENAN
Title or Position: CEO/ ADMINISTRATOR
Credential:
Phone: 551-309-1700