Provider Demographics
NPI:1144203498
Name:CHARLES B. WANG COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CHARLES B. WANG COMMUNITY HEALTH CENTER, INC.
Other - Org Name:CHINATOWN ACTION FOR PROGRESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:212-379-6988
Mailing Address - Street 1:268 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3599
Mailing Address - Country:US
Mailing Address - Phone:212-379-6988
Mailing Address - Fax:212-379-6936
Practice Address - Street 1:268 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3599
Practice Address - Country:US
Practice Address - Phone:212-379-6999
Practice Address - Fax:212-379-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002107R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356318Medicaid
NY00356318Medicaid