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General NPI Number Information
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NPI Number | 1659822963
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTHCARE NETWORK INC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 9704 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-4721
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Country | US
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Telephone | 718-657-7088
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Fax | 718-657-7092
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Provider Business Mailing Address
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Address Line | 60 MADISON AVE 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10010-1600
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Country | US
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Telephone | 212-545-2400
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Fax | 646-312-0481
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Authorized Official
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Title or Position | VP OF FINANCE AND CFO
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Name | ALAN J. WENGROFSKY
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Credential |
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Telephone | 212-545-2481
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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 | 7002119R
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License Number State | NY
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