MEDICARE: HACKENSACK UNIVERSITY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	281P00000X	Chronic Disease Hospital

General Provider Information

NPI Number	:	1952749913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HACKENSACK UNIVERSITY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	118 CHARLTON AVE # B
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1508
Country	:	US
Telephone Number	:	201-257-8065
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 CHARLTON AVE # B
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1508
Country	:	US
Telephone Number	:	201-257-8065
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. NICOLE MARIE COFINI
Credential	:
Telephone Number	:	201-996-2374

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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