Provider Demographics
NPI:1982690087
Name:BOROUGH OF JAMESBURG
Entity Type:Organization
Organization Name:BOROUGH OF JAMESBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BA
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWIDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-521-0339
Mailing Address - Street 1:1000 WASHINGTON ST
Mailing Address - Street 2:C/O DCM INC
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6855
Mailing Address - Country:US
Mailing Address - Phone:732-240-3030
Mailing Address - Fax:732-914-0470
Practice Address - Street 1:131 PERRINEVILLE RD
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1672
Practice Address - Country:US
Practice Address - Phone:732-240-3030
Practice Address - Fax:732-914-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN/A3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004014Medicaid
NJ0004014Medicaid