Provider Demographics
NPI:1497223937
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:JFK HARTWYCK AT CEDAR BROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR FINANCE ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-481-8529
Mailing Address - Street 1:1340 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3227
Mailing Address - Country:US
Mailing Address - Phone:908-754-3100
Mailing Address - Fax:732-632-1644
Practice Address - Street 1:1340 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3227
Practice Address - Country:US
Practice Address - Phone:908-754-3100
Practice Address - Fax:908-754-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315101OtherMEDICARE