Organization
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Active
Parent organization
STATE OF NEW JERSEY
Other names
Green Brook Developmental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF NEW JERSEY
Authorized official
MR. ANTONIO BRINDISI (ACTING CEO)
(732) 968-5566
Entity
Organization
Contact information
Practice address
275 GREENBROOK RD, GREEN BROOK, NJ 08812-2223
(732) 968-6000
(732) 968-0373
Mailing address
275 GREENBROOK RD, GREEN BROOK, NJ 08812-2223
(732) 968-6000
(732) 968-0373
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
25MA04607800
NJ
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
31-G009
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4503309
—
NJ
01
—
528587
MEDICARE BILLING GROUP NU
—
Enumeration date
06/05/2006
Last updated
06/09/2014
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