Provider Demographics
NPI:1023434529
Name:CENTRASTATE MEDICAL CENTER, INC
Entity type:Organization
Organization Name:CENTRASTATE MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-294-7052
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-294-7012
Mailing Address - Fax:732-303-9251
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:BUSINESS OFFICE
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-294-7012
Practice Address - Fax:732-303-9251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRASTATE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-10
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4141008Medicaid
NJ4141016Medicaid
NJ4141024Medicaid
NJ091934OtherMEDICARE
NJ4141016Medicaid