Healthcare Provider Details

I. General information

NPI: 1427965573
Provider Name (Legal Business Name): HOLY NAME SURGERY CENTER AT TEANECK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PALISADE AVE
TEANECK NJ
07666-3144
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-928-2160
  • Fax:
Mailing address:
  • Phone: 201-833-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VASANTHA KONDAMUDI
Title or Position: CMO
Credential:
Phone: 201-833-3599