| Icl Healthcare Choices Inc | |
|
2110 Borden Ave Long Island City NY 11101-4518 | |
| (718) 784-5696 | |
| (347) 649-0663 |
| Full Name | Icl Healthcare Choices Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2110 Borden Ave, Long Island City, New York |
| Authorized Official Name and Position | Maria Siebel (CEO) |
| Authorized Official Contact | 7182340073 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icl Healthcare Choices Inc 6209 16th Ave Brooklyn NY 11204-2702 Ph: (718) 234-0073 | Icl Healthcare Choices Inc 2110 Borden Ave Long Island City NY 11101-4518 Ph: (718) 784-5696 |
| NPI Number | 1215465851 |
|---|---|
| Provider Enumeration Date | 05/26/2017 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215465851 | NPI | - | NPPES |
| 33-1151 | Other | NY | PART A |
| G100253445 | Other | NY | PART B |
| 02186390 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 7001299R (New York) | Primary |
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