Provider Demographics
NPI:1316744485
Name:HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
Entity type:Organization
Organization Name:HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-481-8529
Mailing Address - Street 1:20 PROSPECT AVE STE 719
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1974
Mailing Address - Country:US
Mailing Address - Phone:551-996-5002
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 719
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1974
Practice Address - Country:US
Practice Address - Phone:551-996-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Single Specialty