Provider Demographics
NPI:1629155502
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity Type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:ANCORA PSYCHIATRIC HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-567-7300
Mailing Address - Street 1:301 SPRING GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-9699
Mailing Address - Country:US
Mailing Address - Phone:609-561-1700
Mailing Address - Fax:609-561-1858
Practice Address - Street 1:301 SPRING GARDEN RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2516
Practice Address - Country:US
Practice Address - Phone:609-561-1700
Practice Address - Fax:609-561-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ692705OtherMEDICARE BILLING GROUP
NJ692705OtherMEDICARE BILLING GROUP