NPIMap

Organization Active NPI

Holy Name Hospital Regional Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Teaneck, NJ
National Provider Identifier
1043389349
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HOLY NAME HOSPITAL REGIONAL DIALYSIS CENTER
Practice address
718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone
(201) 833-3000
Fax
(201) 833-4486
NPI assigned
Nov 8, 2006
Last updated
Jul 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Suzanne Juliano
Title
Director, Dialysis Center
Phone
(201) 833-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

718 Teaneck Rd
Teaneck, NJ 07666-4245

Mailing address

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 833-3000

Other identifiers 1

IdentifierTypeStateIssuer
4135407MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110126000050 NJ Part A Provider - Hospital 3971665183 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Englewood, NJ; Hackensack, NJ; Oradell, NJ; Teaneck, NJ; Union City, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043389349. Details of each certification follow.

Hospital certification: CCN 310008

Legal name
HOLY NAME MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 3, 2023
Beds
372
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 24, 1958 in NJ
Enrollment address
718 Teaneck Rd
Teaneck, NJ 76664245
Hospital Psychiatric Unit
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Holy Name Medical CenterCCN 310008 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Santo Gencarelli Individual Contracted Managing EmployeeAd; Aug 26, 2025
Corporate Officer Aug 26, 2025
W-2 Managing EmployeeAd; Aug 26, 2025
Michael Maron Individual Corporate DirectorDirector Aug 1, 2010

Practitioners & affiliated clinicians

Affiliated clinicians 778

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 778

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184284800000",
    "number": "1043389349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664245",
            "telephone_number": "201-833-3000",
            "fax_number": "201-833-4486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664245",
            "telephone_number": "201-833-3000",
            "fax_number": "201-833-4486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLY NAME HOSPITAL REGIONAL DIALYSIS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-13",
        "status": "A",
        "authorized_official_last_name": "JULIANO",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "DIRECTOR, DIALYSIS CENTER",
        "authorized_official_telephone_number": "201-833-3000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4135407",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.