Provider Demographics
NPI:1982642641
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity Type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:WOODBINE DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MSA
Authorized Official - Phone:609-861-6041
Mailing Address - Street 1:1175 DEHIRSCH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-2401
Mailing Address - Country:US
Mailing Address - Phone:609-861-2164
Mailing Address - Fax:609-861-5176
Practice Address - Street 1:1175 DEHIRSCH AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270-2401
Practice Address - Country:US
Practice Address - Phone:609-861-2164
Practice Address - Fax:609-861-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2017-01-09
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
NJ4472004Medicaid
NJ528582OtherPROVIDER GROUP
NJ4472004Medicaid