MEDICARE: BETANCES HEALTH CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	7002208R	NY

General Provider Information

NPI Number	:	1699137257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETANCES HEALTH CENTER

Provider Business Mailing Address
First Line	:	1427 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4202
Country	:	US
Telephone Number	:	212-227-8401
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SANTOS ANTHONY RIVERA
Credential	:	D.S.W.
Telephone Number	:	212-227-8401

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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