Provider Demographics
NPI:1629720925
Name:INNERCITY HEALTH OUTREACH
Entity Type:Organization
Organization Name:INNERCITY HEALTH OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:TOMICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:646-600-5890
Mailing Address - Street 1:14B LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1225
Mailing Address - Country:US
Mailing Address - Phone:646-600-5890
Mailing Address - Fax:
Practice Address - Street 1:14B LEE AVE
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1225
Practice Address - Country:US
Practice Address - Phone:646-600-5890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory