MEDICARE: CENTRAL JERSEY MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	22864	NJ

General Provider Information

NPI Number	:	1982087607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL JERSEY MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1220
Second Line	:	ATTN: CREDENTIALING/HR
City	:	PERTH AMBOY
State	:	NJ
Zip	:	08862
Country	:	US
Telephone Number	:	732-376-6635
Fax Number	:	732-324-5765

Provider Business Practice Location Address
First Line	:	359 13TH AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2125
Country	:	US
Telephone Number	:	973-679-7709
Fax Number	:	732-324-5765

Authorized Official
Title or Position	:	CEO
Name	:	MR. JACK O'LEARY
Credential	:
Telephone Number	:	732-376-9333

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	01/27/2023

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