Provider Demographics
NPI:1396238283
Name:APICHA COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:APICHA COMMUNITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE & ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-884-5380
Mailing Address - Street 1:400 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3698
Mailing Address - Country:US
Mailing Address - Phone:646-884-5380
Mailing Address - Fax:
Practice Address - Street 1:8211 37TH AVE FL 5
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7001
Practice Address - Country:US
Practice Address - Phone:718-567-5200
Practice Address - Fax:212-334-7956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APICHA COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0826701041C0700X
NY0546481223G0001X
NY291180207RI0200X
NY2344212084P0800X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty