Provider Demographics
NPI:1376899708
Name:DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHN
Authorized Official - Prefix:
Authorized Official - First Name:MANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DABOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-476-7636
Mailing Address - Street 1:3433 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3433 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3828
Practice Address - Country:US
Practice Address - Phone:718-476-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496215261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local