Healthcare Provider Details

I. General information

NPI: 1750662672
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 41ST ST
ASTORIA NY
11103-3330
US

IV. Provider business mailing address

60 MADISON AVE 5TH FLOOR
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-7772
  • Fax: 718-482-9648
Mailing address:
  • Phone: 212-545-2439
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7002119R
License Number StateNY

VIII. Authorized Official

Name: ALAN J. WENGROFSKY
Title or Position: CFO
Credential:
Phone: 212-545-2481