Organization · NPI-2

Hackensack Medical Group LLC

Internal Medicine · Hackensack, NJ

NPI number1649904772

StatusActive

Last updated in NPPESJul 14, 2022

Details

NPI: 1649904772
Entity type: Organization (NPI-2)
Legal business name: Hackensack Medical Group LLC
Organization subpart: No
Enumeration date: Jul 14, 2022
Certification date: Jul 14, 2022
Last updated: Jul 14, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207R00000X	Internal Medicine	–	–	Yes
251J00000X	Nursing Care	–	–
261Q00000X	Clinic/Center	–	–
324500000X	Substance Abuse Rehabilitation Facility	–	–
343900000X	Non-emergency Medical Transport (VAN)	–	–

Practice location

341 Essex St
Hackensack, NJ 07601-2048

Phone 973-234-0779 · Fax 973-453-8059

Mailing address

483 S Orange Ave
South Orange, NJ 07079-2642

Phone 973-234-0779 · Fax 973-453-8059

Authorized official

Lionel Anicette
Medical Director
9732340779

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