| James White Manor | |
|
516 Bergen St Newark NJ 07108-1639 | |
| (973) 648-0866 | |
| (973) 648-0078 |
| Full Name | James White Manor |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 516 Bergen St, Newark, New Jersey |
| Authorized Official Name and Position | Peter R. Velez (PRESIDENT/CEO) |
| Authorized Official Contact | 9734831300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| James White Manor 516 Bergen St Newark NJ 07108-1639 Ph: (973) 648-0866 | James White Manor 516 Bergen St Newark NJ 07108-1639 Ph: (973) 648-0866 |
| NPI Number | 1619148160 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 05/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619148160 | NPI | - | NPPES |
| 0055701 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 22238 (New Jersey) | Primary |
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