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92-96 Ferry Street Newark NJ 07105-1817 | |
| (973) 483-1300 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 92-96 Ferry Street, 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 |
|---|---|
741 Broadway Newark NJ 07104-4309 Ph: (973) 483-1300 | 92-96 Ferry Street Newark NJ 07105-1817 Ph: (973) 483-1300 |
| NPI Number | 1366993586 |
|---|---|
| Provider Enumeration Date | 10/24/2016 |
| Last Update Date | 01/29/2025 |
| Medicare PECOS PAC ID | 2163334665 |
|---|---|
| Medicare Enrollment ID | O20170209001498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366993586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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