Organization
ICL HEALTHCARE CHOICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA SIEBEL LCSW (CEO)
(718) 234-0073
Entity
Organization
Contact information
Practice address
2110 BORDEN AVE, LONG ISLAND CITY, NY 11101-4518
(718) 784-5696
(347) 649-0663
Mailing address
6209 16TH AVE, BROOKLYN, NY 11204-2702
(718) 234-0073
(718) 236-8456
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
7001299R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02186390
—
NY
01
—
33-1151
PART A
NY
01
—
G100253445
PART B
NY
Enumeration date
05/26/2017
Last updated
06/11/2019
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