=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295718450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRASTATE MEDICAL CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2005
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 W MAIN ST BUSINESS OFFICE
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-294-7010
-----------------------------------------------------
Fax | 732-303-9251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 W MAIN ST ADMINISTRATION
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-294-2528
-----------------------------------------------------
Fax | 732-462-5129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC DIR, REVENUE CYCLE OPERATIONS
-----------------------------------------------------
Name | JANICE MCAVENIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-294-7012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 11302
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------