NPIMap

Organization Active NPI

Holy Name Primary Care and Specialty Associates, PC

  • Psychiatry Physician
  • Teaneck, NJ
National Provider Identifier
1104256130
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
HOLY NAME PRIMARY CARE AND SPECIALTY ASSOCIATES, PC
Practice address
718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone
(201) 833-3000
Fax
(201) 227-6207
NPI assigned
Nov 12, 2013
Last updated
Sep 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Authorized official

Name
Vasantha Kondamudi, MDNPI 1144238924
Title
Cmo
Phone
(201) 833-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

718 Teaneck Rd
Teaneck, NJ 07666-4245

Mailing address

3 University PLZ Ste 205
Hackensack, NJ 07601-6208

Other practice location 1

354 Old Hook Rd
Westwood, NJ 07675-3246
Phone (201) 358-0400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140509000669 NJ Part B Supplier - Clinic/Group Practice 4082847447 Receives reassigned benefits from 56 practitioners
Practice locations: Teaneck, NJ; Westwood, NJ; Secaucus, NJ; Cliffside Park, NJ; Closter, NJ; North Bergen, NJ; Fort Lee, NJ

National Provider Directory

National Provider Directory

Locations

1220 N Market St
Ste 806
Wilmington, DE 19801

201 Laurel Heights Dr
Bridgeton, NJ 08302
Phone (856) 455-4800

106 Grand Ave
Ste 230
Englewood, NJ 07631
Phone (201) 608-0100

3 University Plz
Hackensack, NJ 07601
Phone (702) 591-5696

433 Hackensack Ave
Ste 205
Hackensack, NJ 07601

7817 Bergenline Ave
North Bergen, NJ 07047
Phone (201) 861-0022

56 Hamilton Ave
Passaic, NJ 07055
Phone (201) 854-5400

222 Cedar Ln
Teaneck, NJ 07666
Phone (201) 227-9444

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

730 Palisade Ave
#1
Teaneck, NJ 07666

730 Palisade Ave
Ste 1
Teaneck, NJ 07666

870 Palisade Ave
Ste 250
Teaneck, NJ 07666

354 Old Hook Rd
Ste 101
Westwood, NJ 07675
Phone (201) 358-0400

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789948800000",
    "number": "1104256130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 UNIVERSITY PLZ STE 205",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016208"
        },
        {
            "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": "201-227-6207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "354 Old Hook Rd",
            "address_purpose": "LOCATION",
            "city": "Westwood",
            "state": "NJ",
            "postal_code": "076753246",
            "country_code": "US",
            "telephone_number": "201-358-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOLY NAME PRIMARY CARE AND SPECIALTY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A",
        "authorized_official_last_name": "KONDAMUDI",
        "authorized_official_first_name": "VASANTHA",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "201-833-3000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.