Provider Demographics
NPI:1376976704
Name:CITY OF NEWARK
Entity Type:Organization
Organization Name:CITY OF NEWARK
Other - Org Name:NEWARK DEPARTMENT OF HEALTH AND COMMUNITY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KETLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-733-7558
Mailing Address - Street 1:110 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1304
Mailing Address - Country:US
Mailing Address - Phone:973-733-7600
Mailing Address - Fax:
Practice Address - Street 1:394 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1221
Practice Address - Country:US
Practice Address - Phone:973-733-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70782261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0390739Medicaid
NJ0390739Medicaid