Healthcare Provider Details

I. General information

NPI: 1700914389
Provider Name (Legal Business Name): HACKETTSTOWN COMMUNITIY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 WILLOW GROVE ST
HACKETTSTOWN NJ
07840-1799
US

IV. Provider business mailing address

653 WILLOW GROVE ST SUITE 2700
HACKETTSTOWN NJ
07840-1732
US

V. Phone/Fax

Practice location:
  • Phone: 908-850-1571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier4141318
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MS. SANDRA POOLAS
Title or Position: MANAGER
Credential:
Phone: 908-850-1571