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258-380 Verona Avenue Newark NJ 07114 | |
| (973) 679-7709 | |
| (732) 324-5765 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 258-380 Verona Avenue, Newark, New Jersey |
| Authorized Official Name and Position | Mark Roberts (CEO) |
| Authorized Official Contact | 7323769333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1220 Perth Amboy NJ 08862-1220 Ph: (732) 376-9333 | 258-380 Verona Avenue Newark NJ 07114 Ph: (973) 679-7709 |
| NPI Number | 1356769277 |
|---|---|
| Provider Enumeration Date | 03/29/2014 |
| Last Update Date | 03/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356769277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New Jersey) | Primary |
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