Provider Demographics
NPI:1093263998
Name:ODA PRIMARY HEALTH CARE NETWORK, INC.
Entity Type:Organization
Organization Name:ODA PRIMARY HEALTH CARE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-260-4600
Mailing Address - Street 1:14 HEYWARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-7823
Mailing Address - Country:US
Mailing Address - Phone:718-260-4600
Mailing Address - Fax:
Practice Address - Street 1:6 DAIRYLAND RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12789
Practice Address - Country:US
Practice Address - Phone:718-260-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODA PRIMARY HEALTH CARE NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-20
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)