Healthcare Provider Details

I. General information

NPI: 1659848489
Provider Name (Legal Business Name): HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 POLIFLY RD
HACKENSACK NJ
07601-3287
US

IV. Provider business mailing address

3349 HWY 138 BUILDING C SUITE A
WALL TOWNSHIP NJ
07719-9671
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-1166
  • Fax: 201-487-3835
Mailing address:
  • Phone: 732-751-3624
  • Fax: 732-751-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier315295
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICARE

VIII. Authorized Official

Name: MR. RICHARD HAND
Title or Position: SENIOR FINANCE ADMINISTRATION
Credential:
Phone: 732-481-8529