=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306891791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL JERSEY MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 07/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 HOBART ST
-----------------------------------------------------
City | PERTH AMBOY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08861-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-376-9333
-----------------------------------------------------
Fax | 732-324-5765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1220
-----------------------------------------------------
City | PERTH AMBOY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08862-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-376-6635
-----------------------------------------------------
Fax | 732-324-5765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HR DIRECTOR
-----------------------------------------------------
Name | MRS. MARTA FERREIRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-376-6615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | 22864
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------