NPIMap

Organization Active NPI

Nycdohmh Hillside Avenue Health Center

  • Community Health Clinic/Center
  • Jamaica, NY
National Provider Identifier
1285680389
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
7002112R5621 Issued in NY
Legal business name
NYCDOHMH HILLSIDE AVENUE HEALTH CENTER
Practice address
164 21 Hillside Avenue
Nycdohmh Hillside Avenue Health Center
Jamaica, NY 11432-4140
Phone
(718) 676-2259
Fax
(718) 262-8885
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael James Smook, MPA
Title
Administrative Manager Third Party
Phone
(212) 442-8468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 7002112R5621 NY Primary

Addresses

Primary practice location

164 21 Hillside Avenue
Nycdohmh Hillside Avenue Health Center
Jamaica, NY 11432-4140

Mailing address

PO Box 74
125 Worth Street RM 901
New York, NY 10013-4006
Phone (212) 442-8468

Other identifiers 1

IdentifierTypeStateIssuer
00247549MedicaidNY

Other names 1

  • New York City Department of Health and Mental Hygiene Hillside Avenue Other name

National Provider Directory

National Provider Directory
Tax ID family
Rochelle Cherry46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285680389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74",
            "address_2": "125 WORTH STREET RM 901",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134006",
            "telephone_number": "212-442-8468",
            "fax_number": "212-442-8452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 21 HILLSIDE AVENUE",
            "address_2": "NYCDOHMH HILLSIDE AVENUE HEALTH CENTER",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114324140",
            "telephone_number": "718-676-2259",
            "fax_number": "718-262-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NYCDOHMH HILLSIDE AVENUE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMOOK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER THIRD PARTY",
        "authorized_official_telephone_number": "212-442-8468",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NY",
            "license": "7002112R5621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00247549",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New York City Department of Health and Mental Hygiene Hillside Avenue",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.