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Organization Active NPI

Englewood Hospital and Medical Center

  • Psychiatric Hospital Unit
  • Englewood, NJ
National Provider Identifier
1124071980
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
10202 Issued in NJ
Legal business name
ENGLEWOOD HOSPITAL AND MEDICAL CENTER
Practice address
350 Engle St
Englewood, NJ 07631-1808
Phone
(201) 894-3314
Fax
(201) 569-6255
NPI assigned
May 19, 2006
Organization subpart
Yes
Parent organization
ENGLEWOOD HOSPITAL AND MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Douglas A Duchak
Title
President & Ceo
Phone
(201) 894-3002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 10202 NJ Primary

Addresses

Primary practice location

350 Engle St
Englewood, NJ 07631-1808

Mailing address

350 Engle St
Englewood, NJ 07631-1808
Phone (201) 894-3314

Other identifiers 1

IdentifierTypeStateIssuer
4138333MedicaidNJ

Other names 1

  • Englewood Hospital Psych Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210525002222 NJ Part A Provider - Hospital 9133031149 Practice locations: Englewood, NJ

Hospital certification: CCN 31S045

Legal name
ENGLEWOOD HOSPITAL AND MEDICAL CENTER
Organization structure
CorporationNon-profit
Enrollment address
350 Engle St
Englewood, NJ 76311808
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Englewood Hosp Assoc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

22-18 Broadway
Ste 202
Fair Lawn, NJ 07410
Phone (201) 796-5400

637 Route 23
Ste 200
Pompton Plains, NJ 07444
Phone (862) 666-9107

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
Warren Geller Individual Corporate OfficerPresident & Ceo Jan 1, 2013
Anthony Orlando Individual Corporate OfficerSenior VP for Finance and Cfo Jun 1, 2004
W-2 Managing EmployeeSenior VP for Finance and Cfo Jan 1, 2013

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Visiting Nurse Association of Englewood, Inc.Englewood, NJ, CCN 317022 Home health agency 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control (50%)		 Nov 22, 2011
Nov 22, 2011
Visiting Nurse Association of Englewood, Inc.Englewood, NJ, CCN 311526 Hospice 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control		 Nov 22, 2011
Nov 22, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1124071980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076311808",
            "telephone_number": "201-894-3314",
            "fax_number": "201-569-6255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076311808",
            "telephone_number": "201-894-3314",
            "fax_number": "201-569-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENGLEWOOD HOSPITAL AND MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENGLEWOOD HOSPITAL AND MEDICAL CENTER",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "DUCHAK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "201-894-3002"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NJ",
            "license": "10202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4138333",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Englewood Hospital Psych Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.