| Mobile Van | |
|
5301 Broadway West New York NJ 07093-2622 | |
| (201) 866-9320 | |
| (201) 392-9084 |
| Full Name | Mobile Van |
|---|---|
| Speciality | Clinic/Center |
| Location | 5301 Broadway, West New York, New Jersey |
| Authorized Official Name and Position | Michael Shababb (INTERIM PRESIDENT/CEO) |
| Authorized Official Contact | 2018662388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Van 800 31st St Union City NJ 07087-2428 Ph: (201) 210-0100 | Mobile Van 5301 Broadway West New York NJ 07093-2622 Ph: (201) 866-9320 |
| NPI Number | 1659323442 |
|---|---|
| Provider Enumeration Date | 05/17/2006 |
| Last Update Date | 05/23/2013 |
| Medicare PECOS PAC ID | 6103887997 |
|---|---|
| Medicare Enrollment ID | O20081208000669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659323442 | NPI | - | NPPES |
| 0022705 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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