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Organization
HACKENSACK MEDICAL GROUP LLC
Active
Organization
HACKENSACK MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LIONEL ANICETTE JR. MD (MEDICAL DIRECTOR)
(973) 234-0779
Entity
Organization
Contact information
Practice address
341 ESSEX ST, HACKENSACK, NJ 07601-2048
(973) 234-0779
(973) 453-8059
Mailing address
483 S ORANGE AVE, SOUTH ORANGE, NJ 07079-2642
(973) 234-0779
(973) 453-8059
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
251J00000X
Nursing Care Agency
—
NULL
261Q00000X
Clinic/Center
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
Other
Enumeration date
07/14/2022
Last updated
07/14/2022
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