MEDICARE: IRONBOUND COMMUNITY HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1619568227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRONBOUND COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	788 MOUNT PROSPECT AVE FL 2
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3221
Country	:	US
Telephone Number	:	973-433-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	788 MOUNT PROSPECT AVE FL 2
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3221
Country	:	US
Telephone Number	:	973-433-9773
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. NURIS RODRIGUEZ-PABON
Credential	:	LCSW
Telephone Number	:	973-433-9773

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/17/2026

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