Provider Demographics
NPI:1972206258
Name:CITY OF NEWARK
Entity type:Organization
Organization Name:CITY OF NEWARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO & DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KETLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-733-5310
Mailing Address - Street 1:110 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1304
Mailing Address - Country:US
Mailing Address - Phone:973-424-4271
Mailing Address - Fax:973-353-8438
Practice Address - Street 1:701 SOUTH ORANGE AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-2209
Practice Address - Country:US
Practice Address - Phone:800-734-7083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0959961Medicaid