Provider Demographics
NPI:1972778413
Name:NEWARK COMMUNITY HEALTH CENTERS INC
Entity type:Organization
Organization Name:NEWARK COMMUNITY HEALTH CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORATE
Authorized Official - Phone:973-483-1300
Mailing Address - Street 1:741 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4309
Mailing Address - Country:US
Mailing Address - Phone:973-483-1300
Mailing Address - Fax:973-483-3787
Practice Address - Street 1:1150 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2441
Practice Address - Country:US
Practice Address - Phone:973-399-6292
Practice Address - Fax:973-372-4534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWARK COMMUNITY HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
NJ23134261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0179965Medicaid
NJ23134OtherSTATE LICENSE
NJ23134OtherSTATE LICENSE