NPIMap

Organization Active NPI

Holy Name Medical Center Inc.

  • General Acute Care Hospital
  • Teaneck, NJ
National Provider Identifier
1104859131
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
10205 Issued in NJ
Legal business name
HOLY NAME MEDICAL CENTER INC.
Practice address
718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone
(201) 833-7016
Fax
(201) 833-3490
NPI assigned
Jul 10, 2006
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Doug Zehner
Title
Cfo
Phone
(201) 833-7016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 10205 NJ Primary

Addresses

Primary practice location

718 Teaneck Rd
Teaneck, NJ 07666-4245

Mailing address

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 833-7013

Other identifiers 2

IdentifierTypeStateIssuer
00325911MedicaidNY
4135407MedicaidNJ

Other names 1

  • Holy Name Hospital Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110126000050 NJ Part A Provider - Hospital 3971665183 1 other NPI on this enrollment
Practice locations: Englewood, NJ; Hackensack, NJ; Oradell, NJ; Teaneck, NJ; Union City, NJ
O20191101001219 NJ MDPP Supplier - in-Person MDPP Supplier 3971665183 Practice locations: Teaneck, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104859131. 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 with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0862033Holy Name Hospital Laboratory718 Teaneck Road, Teaneck, NJ 07666AccreditationFeb 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Holy Name Medical Center9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 8

Organizations listed as members of this organization in the National Provider Directory.

Locations

25775 McBean Pkwy
Ste 215
Valencia, CA 91355
Phone (661) 255-2420

106 Grand Ave
#4
Englewood, NJ 07631
Phone 20156736793574

200 Grand Ave
Englewood, NJ 07631
Phone (201) 567-6599

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

Practitioners 64

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 64

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": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1104859131",
    "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": "201-833-7013",
            "fax_number": "201-833-7213"
        },
        {
            "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": "201-833-7016",
            "fax_number": "201-833-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLY NAME MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "ZEHNER",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "201-833-7016"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NJ",
            "license": "10205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00325911",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4135407",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holy Name Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.