Healthcare Provider Details

I. General information

NPI: 1659405710
Provider Name (Legal Business Name): JOSEPH P ADDABBO FAMILY HEALTH CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

IV. Provider business mailing address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-945-1743
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-945-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number070343-1
License Number StateNY

VIII. Authorized Official

Name: DR. JR PETER NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-945-7150