Healthcare Provider Details

I. General information

NPI: 1477485894
Provider Name (Legal Business Name): CHARLES B. WANG COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131-72 40TH ROAD
FLUSHING NY
11354-5137
US

IV. Provider business mailing address

268 CANAL STREET
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 718-587-1300
  • Fax:
Mailing address:
  • Phone: 212-379-6988
  • Fax: 212-379-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KAUSHAL CHALLA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 212-379-6988