Provider Demographics
NPI:1528401833
Name:FRESENIUS MEDICAL CARE HACKENSACK, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE HACKENSACK, LLC
Other - Org Name:FRESENIUS MEDICAL CARE HACKENSACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:458 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1519
Mailing Address - Country:US
Mailing Address - Phone:201-342-0801
Mailing Address - Fax:201-342-0802
Practice Address - Street 1:458 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1519
Practice Address - Country:US
Practice Address - Phone:201-342-0801
Practice Address - Fax:201-342-0802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ312626Medicare Oscar/Certification