Healthcare Provider Details

I. General information

NPI: 1548123557
Provider Name (Legal Business Name): ODA PRIMARY HEALTH CARE NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 WALLABOUT ST
BROOKLYN NY
11206-5847
US

IV. Provider business mailing address

74 WALLABOUT STREET
BROOKLYN NY
11249-7830
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-4600
  • Fax: 718-797-9075
Mailing address:
  • Phone: 718-260-4600
  • Fax: 718-797-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ABRAHAM J. PEARL
Title or Position: CFO
Credential:
Phone: 718-260-4600