NPIMap

Organization Active NPI

Central Jersey Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Perth Amboy, NJ
National Provider Identifier
1306891791
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
22864 Issued in NJ
Legal business name
CENTRAL JERSEY MEDICAL CENTER, INC.
Practice address
275 Hobart St
Perth Amboy, NJ 08861-4310
Phone
(732) 376-9333
Fax
(732) 324-5765
NPI assigned
May 23, 2006
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Mrs. Marta Ferreira
Title
HR Director
Phone
(732) 376-6615

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 22864 NJ Primary

Addresses

Primary practice location

275 Hobart St
Perth Amboy, NJ 08861-4310

Mailing address

PO Box 1220
Perth Amboy, NJ 08862-1220
Phone (732) 376-6635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050712000392 NJ Part B Supplier - Clinic/Group Practice 1456301241 Receives reassigned benefits from 83 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Perth Amboy, NJ; Newark, NJ; Carteret, NJ
O20050729000900 NJ Part A Provider - Federally Qualified Health Center (FQHC) 1456301241 Practice locations: Perth Amboy, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306891791. Details of each certification follow.

Federally qualified health center certification: CCN 311833

Legal name
CENTRAL JERSEY MEDICAL CENTER INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2002
Last certification
Jan 26, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2001 in NJ
Enrollment address
275 Hobart St
Perth Amboy, NJ 88613396

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1540 Roosevelt Ave
Carteret, NJ 07008
Phone (732) 376-6650

101 Ludlow St
Newark, NJ 07114
Phone (973) 565-0355

226 Dayton St
Newark, NJ 07114
Phone (973) 679-7709

246 18th Ave
Newark, NJ 07108
Phone (732) 376-9333

272 Hobart St
#A
Perth Amboy, NJ 08861
Phone (908) 912-4561

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John T O'Leary Individual Corporate OfficerCeo Jun 1, 2018
W-2 Managing EmployeeCeo Jun 1, 2018
John E Jacobi Individual Corporate DirectorBoard Member-Vice Chairperson Jul 1, 2018
Thomas P Hudanish Individual Corporate DirectorBoard Member - Chairperson Jul 1, 2018
Marta Ferreira Individual Corporate DirectorDirector of HR Aug 1, 2017
W-2 Managing EmployeeDirector of HR Aug 1, 2017
Thomas Boggiano Individual Corporate OfficerFinance Director Feb 1, 2017
Corporate DirectorFinance Director Feb 1, 2017
Joel Russo Individual Corporate DirectorBoard Member Jun 1, 2018
Luz M Ramirez Individual Corporate DirectorBoard Member Jun 1, 2018
Prophet N Kates Individual Corporate DirectorBoard Member Jul 1, 2018
Steven P Nagel Individual Corporate DirectorBoard Member Jul 1, 2018
Tyesha S Pichardo Individual Corporate DirectorBoard Member Jun 1, 2018
Herschel Chomsky Individual Corporate DirectorBoard Member Jul 1, 2018

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1306891791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1220",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088621220",
            "telephone_number": "732-376-6635",
            "fax_number": "732-324-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 HOBART ST",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088614310",
            "telephone_number": "732-376-9333",
            "fax_number": "732-324-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL JERSEY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "FERREIRA",
        "authorized_official_first_name": "MARTA",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "732-376-6615",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "22864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perth Amboy, NJ

Sources for this page

Verify at the official NPI Registry.