Provider Demographics
NPI:1386686053
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity Type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:HAGEDORN PSYCHIATRIC HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AYALA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCEDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-537-2141
Mailing Address - Street 1:200 SANATORIUM RD
Mailing Address - Street 2:
Mailing Address - City:GLEN GARDNER
Mailing Address - State:NJ
Mailing Address - Zip Code:08826-3288
Mailing Address - Country:US
Mailing Address - Phone:908-537-2141
Mailing Address - Fax:908-537-3100
Practice Address - Street 1:200 SANATORIUM RD
Practice Address - Street 2:
Practice Address - City:GLEN GARDNER
Practice Address - State:NJ
Practice Address - Zip Code:08826-3288
Practice Address - Country:US
Practice Address - Phone:908-537-2141
Practice Address - Fax:908-537-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ692717OtherMEDICARE
NJ4508203Medicaid
NJ692717OtherMEDICARE