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NPI Code Detail

MEDICARE: WILLIAM F RYAN COMMUNITY HEALTH CENTER INC

MEDICARE: WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)7002243RNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013360528
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Provider Business Mailing Address
First Line : 2381 FREDERICK DOUGLASS BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-1822
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2381 FREDERICK DOUGLASS BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-1822
Country : US
Telephone Number : 212-749-1820
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. JOSE VIRELLA
Credential :
Telephone Number : 212-316-7906
Provider Enumeration Date : 07/20/2016
Last Update Date : 07/15/2024

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