Provider Demographics
NPI:1962756296
Name:NORTH HUDSON COMMUNITY ACTION CORPORATION HEALTH CENTER- MOVIL VAN
Entity type:Organization
Organization Name:NORTH HUDSON COMMUNITY ACTION CORPORATION HEALTH CENTER- MOVIL VAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-866-2388
Mailing Address - Street 1:5301 BROADWAY -MOVIL VAN
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NEW JERSEY
Mailing Address - Zip Code:07093
Mailing Address - Country:UM
Mailing Address - Phone:201-210-0100
Mailing Address - Fax:
Practice Address - Street 1:800 31ST ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2428
Practice Address - Country:US
Practice Address - Phone:201-201-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0282138Medicaid