Provider Demographics
NPI:1477980845
Name:HENRY J AUSTIN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HENRY J AUSTIN HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-278-6012
Mailing Address - Street 1:321 N WARREN STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618
Mailing Address - Country:US
Mailing Address - Phone:609-278-5900
Mailing Address - Fax:609-695-3532
Practice Address - Street 1:433 BELLEVUE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:609-695-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QC1500X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health