Provider Demographics
NPI:1487680294
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity Type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:WOODBRIDGE DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-499-5673
Mailing Address - Street 1:1275 RAHWAY AVENUE
Mailing Address - Street 2:P.O. BOX 189
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-0189
Mailing Address - Country:US
Mailing Address - Phone:732-499-5951
Mailing Address - Fax:
Practice Address - Street 1:1275 RAHWAY AVENUE
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07095-0189
Practice Address - Country:US
Practice Address - Phone:732-499-5951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ528581Medicare ID - Type Unspecified
NJ314096Medicare Oscar/Certification