# DEPARTEMENT OF HEALTH AND MENTAL HYGIENE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104176395
- **Authorized official:** MR. JOHN CABAN RN (PATIENT CARE MANAGER)
- **Authorized official phone:** (718) 476-7123

## Contact information

- **Practice address:** 3433 JUNCTION BLVD, JACKSON HEIGHTS, NY 11372-3828
- **Practice address phone:** (718) 476-7636
- **Practice address fax:** (718) 476-7131
- **Mailing address:** 3433 JUNCTION BLVD, JACKSON HEIGHTS, NY 11372-3828
- **Mailing address phone:** (718) 476-7636
- **Mailing address fax:** (718) 476-7131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 545218-1 | NY | Yes |

## Other

- **Enumeration date:** 09/14/2012
- **Last updated:** 09/14/2012