=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962097121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HACKENSACK MERIDIAN AMBULATORY CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2021
-----------------------------------------------------
Last Update Date | 02/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 HOSPITAL PLZ STE 101
-----------------------------------------------------
City | OLD BRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08857-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-360-3450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 HOSPITAL PLZ STE 101
-----------------------------------------------------
City | OLD BRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08857-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-360-3450
-----------------------------------------------------
Fax | 732-360-3451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | ROBERT J SCHENK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-836-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------