Healthcare Provider Details

I. General information

NPI: 1972658508
Provider Name (Legal Business Name): STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DRIVE
PARAMUS NJ
07652-4100
US

IV. Provider business mailing address

1 VETERANS DRIVE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-8212
  • Fax: 201-967-8658
Mailing address:
  • Phone: 201-634-8510
  • Fax: 201-967-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060228
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAMUEL P MATHEW
Title or Position: ACCOUNTANT
Credential:
Phone: 201-634-8515