Provider Demographics
NPI:1780760405
Name:HOLY NAME MEDICAL CENTER INC
Entity type:Organization
Organization Name:HOLY NAME MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-833-7016
Mailing Address - Street 1:718 TEANECK ROAD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4249
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:201-530-7900
Practice Address - Street 1:718 TEANECK ROAD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4249
Practice Address - Country:US
Practice Address - Phone:201-833-3000
Practice Address - Fax:201-530-7900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY NAME MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4146603Medicaid
NJ317077Medicare UPIN
NJ317077Medicare Oscar/Certification