Provider Demographics
NPI:1396037149
Name:HOLY NAME MEDICAL CENTER
Entity type:Organization
Organization Name:HOLY NAME MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-926-6982
Mailing Address - Street 1:718 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4245
Mailing Address - Country:US
Mailing Address - Phone:201-227-6055
Mailing Address - Fax:201-530-7900
Practice Address - Street 1:12 W SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-3213
Practice Address - Country:US
Practice Address - Phone:551-248-4800
Practice Address - Fax:201-357-8216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY NAME MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-12
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02C011315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0262749Medicaid