1215437553 NPI number — HACKENSACK MERIDIAN AMBULATORY CARE, INC.

Table of content: (NPI 1215437553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215437553 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:
HACKENSACK MERIDIAN AT HOME INFUSION
Provider Other Organization Name Type Code:
3
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:
1215437553
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:
80 INDUSTRIAL RD STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-785-7350
Provider Business Practice Location Address Fax Number:
973-785-7351
Provider Enumeration Date:
02/13/2018

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: HP0278600 . This is a "NEW JERSEY DIVISION OF CONSUMER AFFAIRS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0756059 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28RS00764400 . This is a "NEW JERSEY BOARD OF PHARMACY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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