Healthcare Provider Details

I. General information

NPI: 1871848234
Provider Name (Legal Business Name): JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DRIVE
ARVERNE NY
11692-3909
US

IV. Provider business mailing address

6200 BEACH CHANNEL DRIVE
ARVERNE NY
11692
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-945-2596
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-945-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number7003234R
License Number StateNY

VIII. Authorized Official

Name: DR. MARJORIE J. HILL
Title or Position: CEO
Credential: PHD
Phone: 718-945-7150