Healthcare Provider Details

I. General information

NPI: 1093878365
Provider Name (Legal Business Name): EMMA BOWEN COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W. 135 ST APT.1
NEW YORK NY
10030
US

IV. Provider business mailing address

215 WEST 135 ST APT.1
NY NY
10030
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-3500
  • Fax: 212-694-4998
Mailing address:
  • Phone: 212-694-3500
  • Fax: 212-694-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL HARGROW
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 212-694-3500