Provider Demographics
NPI:1376638064
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:HACKENSACK MERIDIAN AT HOME OCEAN COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:732-751-3713
Mailing Address - Street 1:1759 ROUTE 88
Mailing Address - Street 2:SUITE 100 LAURELTON PLAZA
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-206-8100
Mailing Address - Fax:732-206-8101
Practice Address - Street 1:1759 ROUTE 88
Practice Address - Street 2:SUITE 100 LAURELTON PLAZA
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-206-8100
Practice Address - Fax:732-206-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22366251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF16588OtherHEALTHNET
NJ920304OtherAETNA
NJ8778108Medicaid
NJOC000008401OtherAMERICHOICE
NJ317075OtherHORIZON BLUE CROSS BLUE S
NJ23434OtherAMERIGROUP
NJ317075OtherEMPIRE BLUE CROSS BLUE SH
NJ=========OtherHEALTHCARE PAYORS COALITI
NJ=========OtherNJ MANUFACTURERS
NJ23434OtherAMERIGROUP
NJ=========OtherPHCS
NJ=========OtherUNIFORM FAMILY HEALTH SER
NJF16588OtherHEALTHNET
NJOC000008401OtherAMERICHOICE
NJ317075OtherHORIZON BLUE CROSS BLUE S
NJ=========OtherFIRST HEALTH
NJ=========OtherVETERANS ADMINISTRATION
NJ=========OtherDEVON
NJ=========OtherUNITED HEALTHCARE
NJ=========OtherCHN