Organization
CENTRASTATE MEDICAL CENTER, INC
Active
Parent organization
CENTRASTATE MEDICAL CENTER, INC.
Other names
MultiSpecialty Physicians of CentraState
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRASTATE MEDICAL CENTER, INC.
Authorized official
DEBORAH CONNORS (VP, REVENUE CYCLE)
(732) 294-7052
Entity
Organization
Contact information
Practice address
901 W MAIN ST, BUSINESS OFFICE, FREEHOLD, NJ 07728-2537
(732) 294-7012
(732) 303-9251
Mailing address
901 W MAIN ST, BUSINESS OFFICE, FREEHOLD, NJ 07728-2537
(732) 294-7012
(732) 303-9251
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
091934
MEDICARE
NJ
05
—
4141008
—
NJ
05
—
4141016
—
NJ
05
—
4141024
—
NJ
Enumeration date
03/10/2014
Last updated
10/16/2020
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