Provider Demographics
NPI:1295718450
Name:CENTRASTATE MEDICAL CENTER, INC
Entity type:Organization
Organization Name:CENTRASTATE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIR, REVENUE CYCLE OPERATIONS
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:ADMINISTRATION
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-294-2528
Mailing Address - Fax:732-462-5129
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:BUSINESS OFFICE
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11302282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4141008Medicaid
NJ4141016Medicaid
NJ4141008Medicaid
NJ4141016Medicaid