Healthcare Provider Details

I. General information

NPI: 1538383666
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 FIRST STREET
ELIZABETH NJ
07206-1000
US

IV. Provider business mailing address

1700 MYRTLE AVE
PLAINFIELD NJ
07063-1000
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-4459
  • Fax: 908-355-4985
Mailing address:
  • Phone: 908-753-6401
  • Fax: 908-226-6743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06505500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA5775700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05775700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA04375900
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. DERRICK C WILLIAMS
Title or Position: VICE PRESIDENT & COO
Credential:
Phone: 908-753-6401