NPIMap

Organization Active NPI

Oda Primary Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
National Provider Identifier
1396293379
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
517 Park Ave
Brooklyn, NY 11205-1783
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 NU Primary

Addresses

Primary practice location

517 Park Ave
Brooklyn, NY 11205-1783

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
O20110725000527 NY Part A Provider - Federally Qualified Health Center (FQHC) 8729123815 1 other NPI on this enrollment
Practice locations: Brooklyn, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396293379. Details of each certification follow.

Federally qualified health center certification: CCN 331042

Legal name
ODA PRIMARY HEALTH CARE NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 15, 2011
Last certification
Aug 15, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1974 in NY
Enrollment address
517 Park Ave
Brooklyn, NY 11205-1783
Related CCNs
331834

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

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
Oda Primary Health Care Network Mobile Clinic14 organizations share this tax ID, including this one
Part of
Oda Primary Health Care Network Mobile Clinic

Other organizations with this tax ID 13

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

View all 13

Locations

14 Heyward St
Brooklyn, NY 11249
Phone 71826046001035

779 E New York Ave
Brooklyn, NY 11203
Phone (201) 389-8614

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Aron Engel Individual Corporate DirectorBoard Member May 5, 2015
Chavie Lieberman Individual Corporate DirectorBoard Member May 5, 2015
Rose Rosenfeld Individual Corporate OfficerChief Financial Officer Jun 3, 2015
Operational/Managerial Control Jun 3, 2015
Joseph Deutsch Individual Corporate OfficerCeo May 5, 2013
Abraham Pearl Individual Corporate OfficerCfo Jan 1, 2023
W-2 Managing EmployeeCfo Jan 1, 2023

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1396293379",
    "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": "517 PARK AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112051783",
            "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.