Provider Demographics
NPI:1659848489
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:HACKENSACK MERIDIAN HEALTH NURSING & REHAB
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 1:3349 HWY 138
Mailing Address - Street 2:BUILDING C SUITE A
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9671
Mailing Address - Country:US
Mailing Address - Phone:732-751-3624
Mailing Address - Fax:732-751-3649
Practice Address - Street 1:50 POLIFLY RD
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3287
Practice Address - Country:US
Practice Address - Phone:201-646-1166
Practice Address - Fax:201-487-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
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
NJ315295OtherMEDICARE