Provider Demographics
NPI:1235179045
Name:NEIGHBORHOOD HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH SERVICES CORPORATION
Other - Org Name:NEIGHBORHOOD HEALTH CENTER - NEWTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-753-6401
Mailing Address - Street 1:1700-58 MYRTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07860
Mailing Address - Country:US
Mailing Address - Phone:908-753-6401
Mailing Address - Fax:908-226-6685
Practice Address - Street 1:238 SPRING STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-383-7001
Practice Address - Fax:973-383-3088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIGHBORHOOD HEALTH SERVICES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 207R00000X
NJ25MA06505500174400000X
NJ25MA5775700207R00000X
NJ25MA04375900208000000X
NJ23445261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0011680Medicaid
NJ0011680Medicaid