Provider Demographics
NPI:1063554178
Name:HANOVER HEALTHCARE LLC
Entity type:Organization
Organization Name:HANOVER HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:973-781-9877
Mailing Address - Street 1:434 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1403
Mailing Address - Country:US
Mailing Address - Phone:973-781-9877
Mailing Address - Fax:973-781-9866
Practice Address - Street 1:434 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1403
Practice Address - Country:US
Practice Address - Phone:973-781-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5670333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3140376OtherNCPDP
NJ7797907Medicaid
NJ7797907Medicaid
NJ1241980001Medicare NSC