# HACKENSACK MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649904772
- **Authorized official:** DR. LIONEL ANICETTE JR. MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (973) 234-0779

## Contact information

- **Practice address:** 341 ESSEX ST, HACKENSACK, NJ 07601-2048
- **Practice address phone:** (973) 234-0779
- **Practice address fax:** (973) 453-8059
- **Mailing address:** 483 S ORANGE AVE, SOUTH ORANGE, NJ 07079-2642
- **Mailing address phone:** (973) 234-0779
- **Mailing address fax:** (973) 453-8059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 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