Healthcare Provider Details

I. General information

NPI: 1184649345
Provider Name (Legal Business Name): HACKENSACK UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

224 E NORTHFIELD RD
LIVINGSTON NJ
07039-4801
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2000
  • Fax: 201-996-4763
Mailing address:
  • Phone: 973-758-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number25MA07954800
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOHN P. FERGUSON
Title or Position: CEO
Credential:
Phone: 201-996-2000