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NPI Code Detail

MEDICARE: SUN RIVER HEALTH INC

MEDICARE: SUN RIVER HEALTH 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)5901200RNY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W38731OTHERNYGROUP MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1295218196
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUN RIVER HEALTH INC
Provider Business Mailing Address
First Line : PO BOX 5036
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10602-5036
Country : US
Telephone Number : 914-734-8800
Fax Number : 914-734-8786
Provider Business Practice Location Address
First Line : 2412 CHURCH AVENUE
Second Line : CHURCH AVENUE CLINIC
City : BROOKLYN
State : NY
Zip : 11226-4005
Country : US
Telephone Number : 855-681-8700
Fax Number : 718-299-1420
Authorized Official
Title or Position : VP INFO/PRACTICE MGMT SYSTEMS
Name : ADAM K. LIPTON
Credential :
Telephone Number : 914-384-2375
Provider Enumeration Date : 09/07/2018
Last Update Date : 03/14/2022

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