=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184709909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HACKENSACK MERIDIAN AMBULATORY CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 05/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 INDUSTRIAL WAY E STE 7A
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-897-7830
-----------------------------------------------------
Fax | 732-897-7831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 INDUSTRIAL WAY E STE 7A
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-897-7830
-----------------------------------------------------
Fax | 732-897-7831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | ANTONIO S VERNACCHIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-421-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------