Provider Demographics
NPI:1578628152
Name:HACKENSACK OCCUPATIONAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:HACKENSACK OCCUPATIONAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-996-3500
Mailing Address - Street 1:360 ESSEX ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8550
Mailing Address - Country:US
Mailing Address - Phone:201-336-8686
Mailing Address - Fax:
Practice Address - Street 1:360 ESSEX ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8550
Practice Address - Country:US
Practice Address - Phone:201-336-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine