MEDICARE: APICHA COMMUNITY HEALTH CENTER

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	1041C0700X	Clinical Social Worker	082670	NY
2	1223G0001X	General Practice Dentistry	054648	NY
3	207RI0200X	Infectious Disease Physician	291180	NY
4	2084P0800X	Psychiatry Physician	234421	NY
5	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1396238283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APICHA COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	400 BROADWAY FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-3698
Country	:	US
Telephone Number	:	646-884-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	8211 37TH AVE FL 5
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7001
Country	:	US
Telephone Number	:	718-567-5200
Fax Number	:	212-334-7956

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE & ACCOUNTS
Name	:	PAULETTE SHERLOCK
Credential	:
Telephone Number	:	646-884-5380

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/21/2023

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