Healthcare Provider Details

I. General information

NPI: 1649618067
Provider Name (Legal Business Name): REFUAH HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LAUREL AVE
SOUTH FALLSBURG NY
12779-5804
US

IV. Provider business mailing address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax:
Mailing address:
  • Phone: 884-354-9300
  • Fax: 845-354-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number4353202R
License Number StateNY

VIII. Authorized Official

Name: MRS. CHANIE STERNBERG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 845-354-9300