Healthcare Provider Details

I. General information

NPI: 1962097121
Provider Name (Legal Business Name): HACKENSACK MERIDIAN AMBULATORY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL PLZ STE 101
OLD BRIDGE NJ
08857-3084
US

IV. Provider business mailing address

3 HOSPITAL PLZ STE 101
OLD BRIDGE NJ
08857-3084
US

V. Phone/Fax

Practice location:
  • Phone: 732-360-3450
  • Fax:
Mailing address:
  • Phone: 732-360-3450
  • Fax: 732-360-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier28RS00782900
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNJ BOARD OF PHARMACY PERMIT

VIII. Authorized Official

Name: ROBERT J SCHENK
Title or Position: VICE PRESIDENT
Credential:
Phone: 732-836-4545