Provider Demographics
NPI:1407573314
Name:HACKENSACK MERIDIAN OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN OUTPATIENT SERVICES, INC.
Other - Org Name:HACKENSACK MERIDIAN IMAGING EATONTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-996-3362
Mailing Address - Street 1:135 RT 35
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:848-308-4902
Mailing Address - Fax:848-308-4989
Practice Address - Street 1:135 RT 35
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:848-308-4902
Practice Address - Fax:848-308-4989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-21
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology