Provider Demographics
NPI:1134476443
Name:JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-945-7150
Mailing Address - Street 1:6200 BEACH CHANNEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692
Mailing Address - Country:US
Mailing Address - Phone:718-945-7150
Mailing Address - Fax:718-945-2596
Practice Address - Street 1:105-34 ROCKAWAY BOULEVARD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417
Practice Address - Country:US
Practice Address - Phone:718-945-7150
Practice Address - Fax:718-945-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003234R261QF0400X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00990152Medicaid
NY00990152Medicaid