| Dayton Street Health Center | |
|
101 Ludlow St Newark NJ 07114-1108 | |
| (973) 565-0355 | |
| (973) 565-0461 |
| Full Name | Dayton Street Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Ludlow St, Newark, New Jersey |
| Authorized Official Name and Position | Pamela Clarke (PRESIDENT/CEO) |
| Authorized Official Contact | 9734831300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dayton Street Health Center 101 Ludlow St Newark NJ 07114-1108 Ph: (973) 565-0355 | Dayton Street Health Center 101 Ludlow St Newark NJ 07114-1108 Ph: (973) 565-0355 |
| NPI Number | 1932370483 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 03/08/2024 |
| Medicare PECOS PAC ID | 2163334665 |
|---|---|
| Medicare Enrollment ID | O20081027000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932370483 | NPI | - | NPPES |
| 0409294 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 70778 (New Jersey) | Primary |
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