Organization
CITY OF NEWARK
Active
Organization
CITY OF NEWARK
Active
Other names
Newark Department of Health and Community Welllness
Organization subpart
No
Provider details
NPI number
Authorized official
KETLEN CREDENTIALING SPECIA ALSBROOK (CEO/DIRECTOR)
(973) 733-5310
Entity
Organization
Contact information
Practice address
110 WILLIAM ST, NEWARK, NJ 07102-1304
(973) 733-7558
Mailing address
110 WILLIAM ST, NEWARK, NJ 07102-1304
(973) 733-7558
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0249351
—
NJ
Enumeration date
04/11/2007
Last updated
07/31/2025
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