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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