Provider Demographics
NPI:1285834069
Name:COMMUNITY HOSPITAL GROUP, INC.
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL GROUP, INC.
Other - Org Name:JFK DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BILLING SERVICES
Authorized Official - Prefix:MISS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-7000
Mailing Address - Street 1:80 JAMES ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3938
Mailing Address - Country:US
Mailing Address - Phone:732-321-7000
Mailing Address - Fax:732-632-1644
Practice Address - Street 1:80 JAMES ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3938
Practice Address - Country:US
Practice Address - Phone:732-321-7000
Practice Address - Fax:732-632-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ222931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3676811Medicaid