Provider Demographics
NPI:1255375929
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS IN MGMT
Authorized Official - Phone:609-894-4001
Mailing Address - Street 1:HWY 72 EAST
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08064-0130
Mailing Address - Country:US
Mailing Address - Phone:609-894-4001
Mailing Address - Fax:609-726-1293
Practice Address - Street 1:RTE 72 EAST
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:NJ
Practice Address - Zip Code:08064-0130
Practice Address - Country:US
Practice Address - Phone:609-894-4001
Practice Address - Fax:609-726-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4467001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ528585OtherMEDICARE BILLING GROUP
NJ528585OtherMEDICARE BILLING GROUP