Organization
CITY OF NEWARK
Active
Other names
Newark Dept of Hlth & Comm Wellness-Dental Mary Eliza Mahoney Hlth Ctr
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLUYINKA FADAHUNSI (FINANCIAL OPERATIONS OFFICER)
(973) 733-7558
Entity
Organization
Contact information
Practice address
110 WILLIAM ST, NEWARK, NJ 07102-1304
(973) 733-7558
(973) 733-4328
Mailing address
110 WILLIAM ST, NEWARK, NJ 07102-1304
(973) 733-7558
(973) 733-4328
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
7082
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0034002
—
NJ
Enumeration date
01/08/2016
Last updated
01/25/2016
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