1124230883 NPI number — CENTRAL JERSEY MEDICAL CENTER, INC

Table of content: (NPI 1124230883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124230883 NPI number — CENTRAL JERSEY MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL JERSEY 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:
Provider Other Organization Name Type Code:
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:
1124230883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08862-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-376-6635
Provider Business Mailing Address Fax Number:
732-324-5765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 QUITMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-424-4329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'LEARY
Authorized Official First Name:
JACK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
732-376-9333

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  23979 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0115045 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0193763 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1342304 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0124869 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0751103 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8462500 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8932603 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0097837 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0183252 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8096201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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