Healthcare Provider Details

I. General information

NPI: 1316981707
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700-58 MYRTLE AVENUE
PLAINFIELD NJ
07063
US

IV. Provider business mailing address

1700-58 MYRTLE AVENUE
PLAINFIELD NJ
07063
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-6401
  • Fax: 908-753-6278
Mailing address:
  • Phone: 908-753-6401
  • Fax: 908-753-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNJ
# 7
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number22271
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0020421
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier0020401
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

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