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General NPI Number Information
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NPI Number | 1548123557
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Entity Type | Organization
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Legal Business Name | ODA PRIMARY HEALTH CARE NETWORK, INC.
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 251 WALLABOUT ST
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City | BROOKLYN
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State | NY
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Zip | 11206-5847
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Country | US
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Telephone | 718-260-4600
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Fax | 718-797-9075
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Provider Business Mailing Address
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Address Line | 74 WALLABOUT STREET
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City | BROOKLYN
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State | NY
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Zip | 11249-7830
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Country | US
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Telephone | 718-260-4600
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Fax | 718-797-9075
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Authorized Official
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Title or Position | CFO
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Name | ABRAHAM J. PEARL
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Credential |
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Telephone | 718-260-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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