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General NPI Number Information
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NPI Number | 1598090292
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 275 HOBART ST MOBILE UNIT
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-4310
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Country | US
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Telephone | 732-376-9333
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Fax | 732-324-5765
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Provider Business Mailing Address
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Address Line | PO BOX 1220
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City | PERTH AMBOY
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State | NJ
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Zip | 08862-1220
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Country | US
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Telephone | 732-376-6635
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Fax | 732-324-5765
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JACK O'LEARY
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Credential |
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Telephone | 732-376-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 24332
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License Number State | NJ
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