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Organization Active NPI

State of New Jersey Omb Centralized Payroll

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Green Brook, NJ
National Provider Identifier
1225077290
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
31-G009 Issued in NJ
Legal business name
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Practice address
275 Greenbrook Rd
Green Brook, NJ 08812-2223
Phone
(732) 968-6000
Fax
(732) 968-0373
NPI assigned
Jun 5, 2006
Last updated
Jun 9, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF NEW JERSEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Antonio Brindisi
Title
Acting Ceo
Phone
(732) 968-5566

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 25MA04607800 NJ
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 31-G009 NJ Primary

Addresses

Primary practice location

275 Greenbrook Rd
Green Brook, NJ 08812-2223

Mailing address

275 Greenbrook Rd
Green Brook, NJ 08812-2223
Phone (732) 968-6000

Other identifiers 2

IdentifierTypeStateIssuer
4503309MedicaidNJ
528587OtherMEDICARE BILLING GROUP NU

Other names 1

  • Green Brook Developmental Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080421000332 NJ Part B Supplier - Clinic/Group Practice 6406742592 Receives reassigned benefits from 4 practitioners
Practice locations: Green Brook, NJ

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Hunterdon Development C22 organizations share this tax ID, including this one
Part of
Hunterdon Development C

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

275 Greenbrook Rd
Green Brook, NJ 08812
Phone (732) 968-6000

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
New Jersey Veterans Memorial Home at ParamusParamus, NJ, CCN 315346 Skilled nursing facility Operational/Managerial Control
Other		 Jul 1, 1995
Jul 1, 1995

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402272000000",
    "number": "1225077290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 GREENBROOK RD",
            "city": "GREEN BROOK",
            "state": "NJ",
            "postal_code": "088122223",
            "telephone_number": "732-968-6000",
            "fax_number": "732-968-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 GREENBROOK RD",
            "city": "GREEN BROOK",
            "state": "NJ",
            "postal_code": "088122223",
            "telephone_number": "732-968-6000",
            "fax_number": "732-968-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW JERSEY",
        "enumeration_date": "2006-06-05",
        "last_updated": "2014-06-09",
        "status": "A",
        "authorized_official_last_name": "BRINDISI",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "ACTING CEO",
        "authorized_official_telephone_number": "732-968-5566",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "25MA04607800",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "31-G009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4503309",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE BILLING GROUP NU",
            "identifier": "528587",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Brook Developmental Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Green Brook, NJ

Sources for this page

Verify at the official NPI Registry.