Provider Demographics
NPI:1558118513
Name:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER INC
Entity type:Organization
Organization Name:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-699-7200
Mailing Address - Street 1:107 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4002
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:914-699-0837
Practice Address - Street 1:9 UNION LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1728
Practice Address - Country:US
Practice Address - Phone:914-668-6828
Practice Address - Fax:914-664-3507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995522Medicaid