Provider Demographics
NPI:1528143336
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:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-3713
Mailing Address - Street 1:1340 CAMPUS PARKWAY SUITE A3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-751-3700
Mailing Address - Fax:732-751-3785
Practice Address - Street 1:1340 CAMPUS PARKWAY SUITE A3
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-751-3700
Practice Address - Fax:732-751-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ71303251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJIL8654OtherHEALTHNET
NJ2605672OtherAETNA
NJ8778809Medicaid
NJMO000015401OtherAMERICHOICE
NJ317084OtherHORIZON BLUE CROSS BLUE S
NJ317084OtherEMPIRE BLUE CROSS BLUE SH
NJ23435OtherAMERIGROUP
NJ23435OtherAMERIGROUP
NJ=========OtherVETERANS ADMINISTRATION
NJIL8654OtherHEALTHNET
NJ=========OtherDEVON
NJ=========OtherFIRST HEALTH
NJ=========OtherPHCS
NJ2605672OtherAETNA
NJ317084OtherHORIZON BLUE CROSS BLUE S
NJ=========OtherHEALTHCARE PAYORS COALITI
NJ=========OtherCHN
NJ=========OtherCARECENTRIX GENTIVA
NJ=========OtherUNITED HEALTHCARE
NJ317084Medicare ID - Type Unspecified