=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881238673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HACKENSACK MERIDIAN AMBULATORY CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2019
-----------------------------------------------------
Last Update Date | 02/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 INDUSTRIAL WAY E
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-751-3655
-----------------------------------------------------
Fax | 848-245-8199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 INDUSTRIAL WAY E
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-751-3655
-----------------------------------------------------
Fax | 848-245-8199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR FINANCE ADMINISTRATION
-----------------------------------------------------
Name | MR. RICHARD HAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-481-8529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------