=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114800257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 10TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-531-7533
-----------------------------------------------------
Fax | 212-280-4793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 W 97TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-6450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-531-7533
-----------------------------------------------------
Fax | 212-280-4793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | JOSE J VIRELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-769-7245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------