Provider Demographics
NPI:1609593722
Name:HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
Other - Org Name:HACKENSACK UNIVERSITY MEDICAL GROUP, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-807-0800
Mailing Address - Street 1:PO BOX 95000-4535
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4535
Mailing Address - Country:US
Mailing Address - Phone:732-807-0800
Mailing Address - Fax:732-922-0548
Practice Address - Street 1:331 NEWMAN SPRINGS RD STE 220
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5688
Practice Address - Country:US
Practice Address - Phone:732-807-0877
Practice Address - Fax:732-922-0548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACKENSACK UNIVERSITY MEDICAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty