Healthcare Provider Details

I. General information

NPI: 1710304563
Provider Name (Legal Business Name): CENTRAL JERSEY MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOBART ST
PERTH AMBOY NJ
08861-3396
US

IV. Provider business mailing address

PO BOX 1220 ATTN: CREDENTIALING/HR
PERTH AMBOY NJ
08862-1220
US

V. Phone/Fax

Practice location:
  • Phone: 732-376-9333
  • Fax: 732-324-5765
Mailing address:
  • Phone: 732-376-6635
  • Fax: 732-324-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JACK O'LEARY
Title or Position: CEO
Credential:
Phone: 732-376-9333