Provider Demographics
NPI:1528239274
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDSPIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA,MBA
Authorized Official - Phone:732-452-4102
Mailing Address - Street 1:132 EVERGREEN RD
Mailing Address - Street 2:P O BOX 3013
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2484
Mailing Address - Country:US
Mailing Address - Phone:732-452-4100
Mailing Address - Fax:732-452-4180
Practice Address - Street 1:132 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2484
Practice Address - Country:US
Practice Address - Phone:732-452-4100
Practice Address - Fax:732-452-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ051225314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility