1023434529 NPI number — CENTRASTATE MEDICAL CENTER, INC

Table of content: (NPI 1023434529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023434529 NPI number — CENTRASTATE MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRASTATE MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MULTISPECIALTY PHYSICIANS OF CENTRASTATE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023434529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 W MAIN ST
Provider Second Line Business Mailing Address:
BUSINESS OFFICE
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-2537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-294-7012
Provider Business Mailing Address Fax Number:
732-303-9251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 W MAIN ST
Provider Second Line Business Practice Location Address:
BUSINESS OFFICE
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-294-7012
Provider Business Practice Location Address Fax Number:
732-303-9251
Provider Enumeration Date:
03/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CONNORS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, REVENUE CYCLE
Authorized Official Telephone Number:
732-294-7052

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4141008 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4141016 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4141024 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091934 . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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