Provider Demographics
NPI:1982636270
Name:CENTRASTATE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:CENTRASTATE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP, REVENUE INTEGRITY
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAVENIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-294-7012
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-294-7010
Mailing Address - Fax:732-303-9251
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:1 SOUTH, PSYCH DPU
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-294-7010
Practice Address - Fax:732-303-9251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRASTATE MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11302273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
31S111Medicare Oscar/Certification