Provider Demographics
NPI:1457509093
Name:CENTRAL MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CENTRAL MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-248-7700
Mailing Address - Street 1:576 CENTRAL AVE
Mailing Address - Street 2:STE LL 8
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1951
Mailing Address - Country:US
Mailing Address - Phone:732-248-7700
Mailing Address - Fax:732-377-8624
Practice Address - Street 1:576 CENTRAL AVE
Practice Address - Street 2:STE LL 8
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1951
Practice Address - Country:US
Practice Address - Phone:732-248-7700
Practice Address - Fax:732-377-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05218100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3822109Medicaid
NJ3822109Medicaid
NJ555063Medicare PIN