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701 South Orange Avenue Newark NJ 07106-2209 | |
| (800) 734-7083 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 701 South Orange Avenue, Newark, New Jersey |
| Authorized Official Name and Position | Ketlen Alsbrook (CEO & DIRECTOR) |
| Authorized Official Contact | 9737335310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
110 William St Newark NJ 07102-1304 Ph: (973) 424-4271 | 701 South Orange Avenue Newark NJ 07106-2209 Ph: (800) 734-7083 |
| NPI Number | 1972206258 |
|---|---|
| Provider Enumeration Date | 03/24/2023 |
| Last Update Date | 04/18/2024 |
| Medicare PECOS PAC ID | 8123169182 |
|---|---|
| Medicare Enrollment ID | O20240610000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972206258 | NPI | - | NPPES |
| 0959961 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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