Healthcare Provider Details

I. General information

NPI: 1376976704
Provider Name (Legal Business Name): CITY OF NEWARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 UNIVERSITY AVE
NEWARK NJ
07102-1221
US

IV. Provider business mailing address

110 WILLIAM ST
NEWARK NJ
07102-1304
US

V. Phone/Fax

Practice location:
  • Phone: 973-733-7600
  • Fax:
Mailing address:
  • Phone: 973-733-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number70782
License Number StateNJ

VIII. Authorized Official

Name: MRS. KETLEN ALSBROOK
Title or Position: CEO/DIRECTOR
Credential:
Phone: 973-733-7558