Provider Demographics
NPI:1952542771
Name:COMMUNITY HEALTHCARE NETWORK, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTHCARE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENGROFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-545-2481
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:FLOOR 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:36-11 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:718-482-7772
Practice Address - Fax:718-482-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2018-07-23
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
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification
WI331009Medicare Oscar/Certification