Provider Demographics
NPI:1336203538
Name:HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - PRIMARY CARE PC
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - PRIMARY CARE PC
Other - Org Name:MERIDIAN MEDICAL GROUP-PRIMARY CARE 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:MD
Authorized Official - Phone:732-807-0800
Mailing Address - Street 1:PO BOX 95000-7730
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:732-807-0800
Mailing Address - Fax:327-922-0527
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:732-807-0800
Practice Address - Fax:327-922-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0308714Medicaid
NJ111555Medicare PIN