# STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF NEW JERSEY
- **Other names:** Green Brook Developmental Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1225077290
- **Legal business name:** STATE OF NEW JERSEY
- **Authorized official:** MR. ANTONIO BRINDISI (ACTING CEO)
- **Authorized official phone:** (732) 968-5566

## Contact information

- **Practice address:** 275 GREENBROOK RD, GREEN BROOK, NJ 08812-2223
- **Practice address phone:** (732) 968-6000
- **Practice address fax:** (732) 968-0373
- **Mailing address:** 275 GREENBROOK RD, GREEN BROOK, NJ 08812-2223
- **Mailing address phone:** (732) 968-6000
- **Mailing address fax:** (732) 968-0373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 25MA04607800 | NJ | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 31-G009 | NJ | Yes |

## Other

- **Enumeration date:** 06/05/2006
- **Last updated:** 06/09/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4503309 | — | NJ |
| 01 | — | 528587 | MEDICARE BILLING GROUP NU | — |