1184709909 NPI number — HACKENSACK MERIDIAN AMBULATORY CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184709909 NPI number — HACKENSACK MERIDIAN AMBULATORY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184709909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 INDUSTRIAL WAY E STE 7A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATONTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-897-7830
Provider Business Mailing Address Fax Number:
732-897-7831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 INDUSTRIAL WAY E STE 7A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-897-7830
Provider Business Practice Location Address Fax Number:
732-897-7831
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VERNACCHIA
Authorized Official First Name:
ANTONIO
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
201-421-1100

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28RS00650900 . This is a "NEW JERSEY BOARD OF PHARMACY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0756091 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP0065600 . This is a "NEW JERSEY DIVISION OF CONSUMER AFFAIRS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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