Provider Demographics
NPI:1235192675
Name:HACKENSACK ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:HACKENSACK ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BALDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-498-0030
Mailing Address - Street 1:170 PROPECT AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1820
Mailing Address - Country:US
Mailing Address - Phone:201-498-0030
Mailing Address - Fax:201-708-6300
Practice Address - Street 1:170 PROPECT AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1820
Practice Address - Country:US
Practice Address - Phone:201-498-0030
Practice Address - Fax:201-708-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23065261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical