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General NPI Number Information
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NPI Number | 1013680727
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Entity Type | Organization
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Legal Business Name | HOLY NAME PRIMARY CARE AND SPECIALTY ASSOCIATES, PC
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 354 OLD HOOK RD STE 102
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City | WESTWOOD
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State | NJ
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Zip | 07675-3247
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Country | US
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Telephone | 201-833-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3 UNIVERSITY PLZ STE 205
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City | HACKENSACK
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State | NJ
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Zip | 07601-6208
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Country | US
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Telephone | 201-833-3599
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | PATRICIA BENIQUEZ PACHECO
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Credential |
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Telephone | 201-833-3599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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