Healthcare Provider Details

I. General information

NPI: 1942451836
Provider Name (Legal Business Name): HAKENSACK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 2ND ST
HACKENSACK NJ
07601-2050
US

IV. Provider business mailing address

33-37 NEW YORK AVE APT 2A
NEWARK NJ
07105-1281
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-8336
  • Fax:
Mailing address:
  • Phone: 973-491-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number26NJ00145300
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MELINDA WEBER
Title or Position: APN SUPERVISOR
Credential: MSN, ANP- BC
Phone: 201-996-8336