Healthcare Provider Details

I. General information

NPI: 1124396874
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89-44 164TH ST
JAMAICA NY
11432-6103
US

IV. Provider business mailing address

44 W 28TH STREET 5TH FLOOR
NEW YORK NY
10001-4212
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-2123
  • Fax: 718-523-5833
Mailing address:
  • Phone: 212-545-2409
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number7002119R
License Number StateNY

VIII. Authorized Official

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