Provider Demographics
NPI:1609897453
Name:BETANCES HEALTH CENTER
Entity Type:Organization
Organization Name:BETANCES HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:212-227-8401
Mailing Address - Street 1:280 HENRY ST
Mailing Address - Street 2:BETANCES HEALTH CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4816
Mailing Address - Country:US
Mailing Address - Phone:212-227-8401
Mailing Address - Fax:212-227-8842
Practice Address - Street 1:280 HENRY ST.
Practice Address - Street 2:BETANCES HEALTH CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4816
Practice Address - Country:US
Practice Address - Phone:212-227-8401
Practice Address - Fax:212-227-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243045Medicaid
NY331860Medicare Oscar/Certification
NY00243045Medicaid