Provider Demographics
NPI:1881891307
Name:CENTRAL PHYSICIAN SERVICES, P.A.
Entity type:Organization
Organization Name:CENTRAL PHYSICIAN SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-212-0051
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0052
Practice Address - Street 1:300 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2819
Practice Address - Country:US
Practice Address - Phone:973-672-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02040857OtherNY MEDICAID
NJ7735405Medicaid
NJ1137829OtherHORIZON NJ HEALTH
NJCI1325 & DB1263OtherRAILROAD MEDICARE
NJG985557OtherOXFORD
NJ=========OtherHORIZON BC BS OF NJ
NJG985557OtherOXFORD