Healthcare Provider Details

I. General information

NPI: 1184791923
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97-04 SUTPHIN BLVD
JAMAICA NY
11435-4721
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 718-657-7088
  • Fax: 718-657-7092
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 Number
License Number StateNY

VIII. Authorized Official

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