Provider Demographics
NPI:1063057024
Name:HACKENSACK MERIDIAN NUTRITION
Entity type:Organization
Organization Name:HACKENSACK MERIDIAN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-807-0877
Mailing Address - Street 1:27 S COOKS BRIDGE RD STE 1-03
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2460
Mailing Address - Country:US
Mailing Address - Phone:732-928-1126
Mailing Address - Fax:609-601-1162
Practice Address - Street 1:27 S COOKS BRIDGE RD STE 1-03
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2460
Practice Address - Country:US
Practice Address - Phone:732-928-1126
Practice Address - Fax:609-601-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty