Provider Demographics
NPI:1306440078
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:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANEKAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:908-427-6010
Mailing Address - Street 1:34 INDUSTRIAL WAY E STE 4
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:908-427-6010
Mailing Address - Fax:908-427-6099
Practice Address - Street 1:34 INDUSTRIAL WAY E STE 4
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3319
Practice Address - Country:US
Practice Address - Phone:908-427-6010
Practice Address - Fax:908-427-6099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HMH HOSPITALS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-24
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00781300OtherPHARMACY LICENSE