=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861891913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRASTATE MEDICAL CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2014
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 W MAIN ST BUSINESS OFFICE
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-294-7012
-----------------------------------------------------
Fax | 732-303-9251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 W MAIN ST BUSINESS OFFICE
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-294-7012
-----------------------------------------------------
Fax | 732-303-9251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, REVENUE CYCLE
-----------------------------------------------------
Name | DEBORAH CONNORS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-294-7052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 11302
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------