Organization
CITY OF NEWARK
Active
Organization
CITY OF NEWARK
Active
Other names
Newark Department of Health and Community Wellness/Mary Eliza Mahoney
Organization subpart
No
Provider details
NPI number
Authorized official
KETLEN ALSBROOK (CEO & DIRECTOR)
(973) 733-5310
Entity
Organization
Contact information
Practice address
701 SOUTH ORANGE AVENUE, NEWARK, NJ 07106-2209
(800) 734-7083
Mailing address
110 WILLIAM ST, NEWARK, NJ 07102-1304
(973) 424-4271
(973) 353-8438
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0959961
—
NJ
Enumeration date
03/24/2023
Last updated
04/18/2024
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