NPIMap

Organization Active NPI

Oda Primary Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Monticello, NY
National Provider Identifier
1376091363
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ODA PRIMARY HEALTH CARE NETWORK, INC.
Practice address
60 Jefferson St
Suite 1
Monticello, NY 12701-1122
Phone
(718) 260-4600
NPI assigned
Sep 19, 2016
Last updated
Jan 4, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ODA PRIMARY HEALTH CARE NETWORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Rose Rosenfeld
Title
Cfo
Phone
(718) 260-4600

Specialties & licenses 1

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

Addresses

Primary practice location

60 Jefferson St
Suite 1
Monticello, NY 12701-1122

Mailing address

14 Heyward St
Brooklyn, NY 11249-7823
Phone (718) 260-4600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150819009123 NY Part A Provider - Federally Qualified Health Center (FQHC) 8729123815 1 other NPI on this enrollment
Practice locations: Monticello, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376091363. Details of each certification follow.

Federally qualified health center certification: CCN 331168

Legal name
ODA PRIMARY HEALTH CARE NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 16, 2015
Last certification
Sep 16, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1974 in NY
Enrollment address
60 Jefferson St
Monticello, NY 12701-1122

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Robert B Krausz14 organizations share this tax ID, including this one
Part of
Robert B Krausz

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Issac a Katz Individual Corporate DirectorBoard Member Mar 1, 2003
Aron Engel Individual Corporate DirectorBoard Member May 1, 2010
Akiva Kobre Individual Corporate DirectorBoard Member Nov 1, 2013
Chavie Lieberman Individual Corporate DirectorBoard Member Jan 1, 1992
Joseph Deutsch Individual Corporate OfficerCeo Jan 7, 2013
Moshe Friedman Individual Corporate DirectorBoard Member Dec 1, 2009
Abraham Pearl Individual Corporate Director Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
Naftali Ausch Individual Corporate DirectorBoard Member Dec 31, 1988
Naftali Horowitz Individual Corporate DirectorBoard Member Mar 1, 2003
Abraham Friedlander Individual Corporate DirectorBoard Member Nov 1, 1991

NPI Registry JSON

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1376091363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 HEYWARD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112497823",
            "telephone_number": "718-260-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 JEFFERSON ST",
            "address_2": "SUITE 1",
            "city": "MONTICELLO",
            "state": "NY",
            "postal_code": "127011122",
            "telephone_number": "718-260-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODA PRIMARY HEALTH CARE NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ODA PRIMARY HEALTH CARE NETWORK, INC.",
        "enumeration_date": "2016-09-19",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "ROSENFELD",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "718-260-4600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, NY

Sources for this page

Verify at the official NPI Registry.