City Of Newark
Clinic/Center, Federally Qualified Health Center (FQHC) in Newark, NJ. Organization (NPI-2).
NPI number1104647635
StatusActive
Last updated in NPPESSep 9, 2025
Details
- NPI
- 1104647635
- Entity type
- Organization (NPI-2)
- Legal business name
- City Of Newark
- Organization subpart
- No
- Enumeration date
- Oct 17, 2024
- Certification date
- Sep 9, 2025
- Last updated
- Sep 9, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
Other names
- Newark Dept Of Health And Community Wellness Dental Mobile Unit (Doing Business As)
Practice location
394 University AveNewark, NJ 07102-1221
Phone 800-734-7083
Mailing address
110 William StNewark, NJ 07102-1304
Phone 973-424-4271 · Fax 973-353-8438
Authorized official
Ketlen Alsbrook
Ceo & Director
9737335310
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