Provider Demographics
NPI:1114348976
Name:HACKENSACK UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:HACKENSACK UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENCY TRAINING
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-996-8316
Mailing Address - Street 1:360 ESSEX ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8550
Mailing Address - Country:US
Mailing Address - Phone:551-996-8316
Mailing Address - Fax:551-996-8221
Practice Address - Street 1:360 ESSEX ST
Practice Address - Street 2:SUITE 403
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8550
Practice Address - Country:US
Practice Address - Phone:551-996-8316
Practice Address - Fax:551-996-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06270300208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty