Provider Demographics
NPI:1811931504
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:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-730-1301
Mailing Address - Street 1:40 PITTSTOWN ROAD
Mailing Address - Street 2:P.O. BOX 4003
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08864
Mailing Address - Country:US
Mailing Address - Phone:908-730-1301
Mailing Address - Fax:908-730-1339
Practice Address - Street 1:40 PITTSTOWN RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1209
Practice Address - Country:US
Practice Address - Phone:908-730-1301
Practice Address - Fax:908-730-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320600000X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
528586OtherMEDICARE BILLING GROUP
NJ4482506Medicaid
314091Medicare Oscar/Certification