NPIMap

Organization Active NPI

City of Newark

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
National Provider Identifier
1295958908
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CITY OF NEWARK
Practice address
110 William St
Newark, NJ 07102-1304
Phone
(973) 733-7558
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Ketlen Credentialing Specia Alsbrook
Title
Ceo/Director
Phone
(973) 733-5310

Specialties & licenses 1

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

Addresses

Primary practice location

110 William St
Newark, NJ 07102-1304

Mailing address

110 William St
Newark, NJ 07102-1304
Phone (973) 733-7558

Other identifiers 1

IdentifierTypeStateIssuer
0249351MedicaidNJ

Other names 1

  • Newark Department of Health and Community Welllness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101229000720 NJ Part A Provider - Federally Qualified Health Center (FQHC) 8123169182 Practice locations: Newark, NJ

Federally qualified health center certification: CCN 311892

Legal name
CITY OF NEWARK
Doing business as
NEWARK DEPARTMENT OF CHILD AND FAMILY WELL BEING
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 5, 2010
Last certification
Oct 5, 2010
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
110 William Street
Newark Department of Child and Family Well Being
Newark, NJ 71021304

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
City of Newark Dept of Child and Family Well Being Mobile Medical Van14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

110 William St
Ste 111
Newark, NJ 07102

110 William St
Ste 112
Newark, NJ 07102

110 William St
Ste B106
Newark, NJ 07102

110 William St
Fl 1
Newark, NJ 07102

110 William St
Ste 114
Newark, NJ 07102

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jason Ndungu Individual Corporate OfficerFinancial Operating Officer May 19, 2019
W-2 Managing EmployeeFinacial Operating Officer May 20, 2019
Ketlen Alsbrook Individual Corporate OfficerCeo Jul 1, 2022 100%
W-2 Managing Employee Jul 1, 2022 100%
Thaddeus Diggs Individual Corporate DirectorBoard Member Sep 21, 2023 100%
Alexandria Massey Individual Corporate OfficerCoo Aug 20, 2022 100%
W-2 Managing EmployeeChief Operating Officer Aug 20, 2022 100%

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1295958908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WILLIAM ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021304",
            "telephone_number": "973-733-7558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 WILLIAM ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021304",
            "telephone_number": "973-733-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF NEWARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "ALSBROOK",
        "authorized_official_first_name": "KETLEN",
        "authorized_official_middle_name": "CREDENTIALING SPECIA",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "973-733-5310"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0249351",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newark Department of Health and Community Welllness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.