NPIMap

Organization Active NPI

Icl Healthcare Choices Inc

  • Federally Qualified Health Center (FQHC)
  • Long Island City, NY
National Provider Identifier
1215465851
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7001299R Issued in NY
Legal business name
ICL HEALTHCARE CHOICES INC
Practice address
2110 Borden Ave
Long Island City, NY 11101-4518
Phone
(718) 784-5696
Fax
(347) 649-0663
NPI assigned
May 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maria Siebel, LCSW
Title
Ceo
Phone
(718) 234-0073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7001299R NY Primary

Addresses

Primary practice location

2110 Borden Ave
Long Island City, NY 11101-4518

Mailing address

6209 16TH Ave
Brooklyn, NY 11204-2702
Phone (718) 234-0073

Other identifiers 3

IdentifierTypeStateIssuer
33-1151OtherNYPART A
G100253445OtherNYPART B
02186390MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Icl Healthcare Choices Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1215465851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6209 16TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042702",
            "telephone_number": "718-234-0073",
            "fax_number": "718-236-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 BORDEN AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111014518",
            "telephone_number": "718-784-5696",
            "fax_number": "347-649-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICL HEALTHCARE CHOICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-26",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SIEBEL",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-234-0073",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7001299R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART A",
            "identifier": "33-1151",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B",
            "identifier": "G100253445",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02186390",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.