| Church Avenue Clinic | |
|
2412 Church Avenue Church Avenue Clinic Brooklyn NY 11226-4005 | |
| (855) 681-8700 | |
| (718) 299-1420 |
| Full Name | Church Avenue Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2412 Church Avenue, Brooklyn, New York |
| Authorized Official Name and Position | Adam K. Lipton (VP INFO/PRACTICE MGMT SYSTEMS) |
| Authorized Official Contact | 9143842375 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Church Avenue Clinic Po Box 5036 White Plains NY 10602-5036 Ph: (914) 734-8800 | Church Avenue Clinic 2412 Church Avenue Church Avenue Clinic Brooklyn NY 11226-4005 Ph: (855) 681-8700 |
| NPI Number | 1295218196 |
|---|---|
| Provider Enumeration Date | 09/07/2018 |
| Last Update Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295218196 | NPI | - | NPPES |
| W38731 | Other | NY | GROUP MEDICARE |
| 00473038 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 5901200R (New York) | Primary |
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