=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568316784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZUFALL HEALTH CENTER - MEDICAL VAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 W BLACKWELL ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07801-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-328-3344
-----------------------------------------------------
Fax | 973-328-9201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 W BLACKWELL ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07801-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | IMOGENE ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-328-9100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------