NPIMap

Organization Active NPI

Joseph P. Addabbo Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jamaica, NY
National Provider Identifier
1467708107
Registry record updated Feb 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7003234R Issued in NY
Legal business name
JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Practice address
11439 Sutphin Blvd
Jamaica, NY 11434-1022
Phone
(718) 945-7150
Fax
(718) 945-2596
NPI assigned
Jul 31, 2012
Last updated
Feb 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2016

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

Authorized official

Name
Dr. Marjorie J. Hill, PHDNPI 1801389697
Title
Ceo
Phone
(718) 945-7150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7003234R NY Primary

Addresses

Primary practice location

11439 Sutphin Blvd
Jamaica, NY 11434-1022

Mailing address

6200 Beach Channel Drive
Arverne, NY 11692
Phone (718) 945-7150

Other identifiers 1

IdentifierTypeStateIssuer
00990152MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040212000038 NY Part A Provider - Federally Qualified Health Center (FQHC) 0749174654 1 other NPI on this enrollment
Practice locations: Jamaica, NY
O20160921001025 NY Part B Supplier - Clinic/Group Practice 0749174654 Receives reassigned benefits from 33 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arverne, NY; Brooklyn, NY; Far Rockaway, NY; Jamaica, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467708107. Details of each certification follow.

Federally qualified health center certification: CCN 331927

Legal name
JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2004
Last certification
Mar 16, 2004
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 1986 in NY
Enrollment address
11439 Sutphin Blvd
Jamaica, NY 11434-1022
Related CCNs
331841

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Joseph P Addabbo Family Health Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

11439 Sutphin Blvd
Jamaica, NY 11434

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Glenn Diresto Individual Corporate DirectorBoard Member Jun 13, 2011
Alfonso Chan Individual Corporate DirectorCmo Jun 13, 2011
Morris Breitstein Individual Corporate OfficerCfo Aug 21, 2017
W-2 Managing EmployeeCfo Aug 21, 2017
Camille Eaddy Individual Corporate DirectorBoard Member Jun 13, 2011
Sylvester Okonkwo Individual Corporate DirectorBoard Member May 14, 2014
Patricia Gillespie Individual Corporate DirectorBoard Member May 14, 2014
Sandy Fogg Individual Corporate DirectorCoo Jun 13, 2011
Saywalah Kesselly Individual Corporate DirectorBoard Member Jun 13, 2011
Betty Leon Individual Corporate DirectorBoard Member Jun 13, 2011
Marjorie Hill Individual Corporate OfficerCeo Apr 24, 2015
W-2 Managing EmployeeCeo Apr 24, 2015
Sandria de Ackbersingh-Twitty Individual Corporate DirectorBoard Member May 14, 2014
Alonzo Belgrave Individual Corporate DirectorBoard Member May 14, 2014
Glenn Greenidge Individual Corporate DirectorBoard Member May 14, 2014
Caldine Rey Individual Corporate DirectorBoard Member Jun 13, 2011
Merril Wright Individual Corporate DirectorBoard Member Jun 13, 2011
Samora Coles Individual Corporate DirectorBoard Member May 14, 2014

Practitioners & affiliated clinicians

Practitioners 9

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": "1343692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1467708107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 BEACH CHANNEL DRIVE",
            "city": "ARVERNE",
            "state": "NY",
            "postal_code": "11692",
            "telephone_number": "718-945-7150",
            "fax_number": "718-945-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11439 SUTPHIN BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114341022",
            "telephone_number": "718-945-7150",
            "fax_number": "718-945-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-31",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "MARJORIE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-945-7150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7003234R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00990152",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.