Healthcare Provider Details

I. General information

NPI: 1306090741
Provider Name (Legal Business Name): NORTH HUDSON COMMUNITY ACTION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E SALEM ST
HACKENSACK NJ
07601-7427
US

IV. Provider business mailing address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2121
  • Fax:
Mailing address:
  • Phone: 201-866-9320
  • Fax: 201-392-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0175081
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: CHRISTOPHER F IRIZARRY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 201-866-2388