NPIMap

Organization Active NPI

Holy Name Medical Center Inc.

Doing business as Holy Name Pavillion

  • Psychiatric Hospital Unit
  • Teaneck, NJ
National Provider Identifier
1609945963
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
10205 Issued in NJ
Legal business name
HOLY NAME MEDICAL CENTER INC.
Doing business as
Holy Name Pavillion
Practice address
718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone
(201) 833-3000
Fax
(201) 833-4486
NPI assigned
Nov 8, 2006
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
HOLY NAME MEDICAL CENTER INC.As reported in NPPES

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
Psychiatric Hospital Unit 273R00000X 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) 833-3000

Other identifiers 1

IdentifierTypeStateIssuer
4135423MedicaidNJ

Other names 1

  • Holy Name Pavillion Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170407001316 NJ Part A Provider - Hospital 3971665183 Practice locations: Teaneck, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609945963. Details of each certification follow.

Hospital certification: CCN 31S008

Legal name
HOLY NAME MEDICAL CENTER INC
Organization structure
CorporationNon-profit
Enrollment address
718 Teaneck Rd
Teaneck, NJ 76664245
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

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).

National Provider Directory

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

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the 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 Director Aug 1, 2010

Practitioners & affiliated clinicians

Practitioners 5

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.

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": "1741132800000",
    "number": "1609945963",
    "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 MEDICAL CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOLY NAME MEDICAL CENTER INC.",
        "enumeration_date": "2006-11-08",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NJ",
            "license": "10205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4135423",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holy Name Pavillion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.