Provider Demographics
NPI:1770847717
Name:ENDOSCOPY CENTER OF HACKENSACK, LLC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF HACKENSACK, LLC
Other - Org Name:HACKENSACK ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:15305 DALLAS PKWY
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4637
Mailing Address - Country:US
Mailing Address - Phone:972-713-3500
Mailing Address - Fax:972-713-3550
Practice Address - Street 1:170 PROSPECT AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1820
Practice Address - Country:US
Practice Address - Phone:201-489-0030
Practice Address - Fax:201-708-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical