MEDICARE: COMMUNITY HEALTH PROJECT 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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	571052	OTHER		MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1295108025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH PROJECT INC.

Provider Business Mailing Address
First Line	:	356 W 18TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4401
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:	212-271-8128

Provider Business Practice Location Address
First Line	:	3144 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4629
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:	212-271-8128

Authorized Official
Title or Position	:	COMPLIANCE ANALYST
Name	:	NICHOLAS MARTIN
Credential	:
Telephone Number	:	212-271-7269

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	03/15/2018

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Directions to “COMMUNITY HEALTH PROJECT INC. ” Practice Location

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