Provider Demographics
NPI:1215437553
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:VERNACCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-421-1100
Mailing Address - Street 1:34 INDUSTRIAL WAY E STE 7A
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3319
Mailing Address - Country:US
Mailing Address - Phone:732-897-7830
Mailing Address - Fax:732-897-7831
Practice Address - Street 1:80 INDUSTRIAL RD STE G
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644
Practice Address - Country:US
Practice Address - Phone:973-785-7350
Practice Address - Fax:973-785-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0278600OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS
NJ0756059Medicaid
NJ28RS00764400OtherNEW JERSEY BOARD OF PHARMACY