Healthcare Provider Details

I. General information

NPI: 1336203538
Provider Name (Legal Business Name): HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5688
US

IV. Provider business mailing address

PO BOX 95000-7730
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 732-807-0800
  • Fax: 327-922-0548
Mailing address:
  • Phone: 732-807-0800
  • Fax: 327-922-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL VARGA
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-807-0800