Provider Demographics
NPI:1447381793
Name:CITY OF HACKENSACK FIRE DEPARTMENT
Entity Type:Organization
Organization Name:CITY OF HACKENSACK FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIEUTENANT
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-646-7800
Mailing Address - Street 1:205 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5506
Mailing Address - Country:US
Mailing Address - Phone:201-646-7800
Mailing Address - Fax:
Practice Address - Street 1:205 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5506
Practice Address - Country:US
Practice Address - Phone:201-646-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHACK00243341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5162301Medicaid
NJ208130Medicare ID - Type Unspecified