Provider Demographics
NPI:1114101607
Name:HENRY J AUSTIN HEALTH CENTER, INC
Entity Type:Organization
Organization Name:HENRY J AUSTIN HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTION/CREDENTIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-278-5976
Mailing Address - Street 1:112 EWING ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1004
Mailing Address - Country:US
Mailing Address - Phone:609-396-9600
Mailing Address - Fax:
Practice Address - Street 1:112 EWING ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1004
Practice Address - Country:US
Practice Address - Phone:609-396-9600
Practice Address - Fax:609-695-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22436261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
311823Medicare Oscar/Certification