NPIMap

Organization Active NPI

Joseph P. Addabbo Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Arverne, NY
National Provider Identifier
1497700736
Registry record updated Aug 15, 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
6200 Beach Channel Dr
Arverne, NY 11692-1409
Phone
(718) 945-7150
Fax
(718) 942-2596
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2016

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

6200 Beach Channel Dr
Arverne, NY 11692-1409

Mailing address

6200 Beach Channel Dr
Arverne, NY 11692-1409
Phone (718) 945-7150

Other identifiers 1

IdentifierTypeStateIssuer
009900152MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040211000902 NY Part A Provider - Federally Qualified Health Center (FQHC) 0749174654 Practice locations: Arverne, NY
O20040212000038 NY Part A Provider - Federally Qualified Health Center (FQHC) 0749174654 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jamaica, NY
O20040212000108 NY Part A Provider - Federally Qualified Health Center (FQHC) 0749174654 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Far Rockaway, NY
O20160921001025 NY Part B Supplier - Clinic/Group Practice 0749174654 Receives reassigned benefits from 33 practitioners
5 other NPIs on this enrollment
Practice locations: Arverne, NY; Brooklyn, NY; Far Rockaway, NY; Jamaica, NY

Federally qualified health center certification: CCN 331841

Legal name
JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1986 in NY
Enrollment address
6200 Beach Channel Dr
Arverne, NY 11692-1409

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

Federally qualified health center certification: CCN 331929

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
Jan 1, 1987 in NY
Enrollment address
1288 Central Ave
Far Rockaway, NY 11691-3909
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

Ownership & related parties

All disclosed owners & managing parties 28

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

NameRoleSinceShare
Camille Eaddy Individual Corporate Director Jun 13, 2011
Corporate DirectorBoard Member Jun 13, 2011
Corporate DirectorBoard Member May 27, 2015
Ari J Benjamin Individual Corporate DirectorCmo Jun 25, 2018
Corporate OfficerCmo Jun 25, 2018 50%
Sylvester Okonkwo Individual Corporate Director Jun 13, 2011
Corporate DirectorBoard Member May 14, 2014
Corporate DirectorBoard Member May 27, 2015
Betty Leon Individual Corporate Director Jun 13, 2011
Corporate DirectorBoard Member Jun 13, 2011
Corporate DirectorBoard Member May 27, 2015
Lydia Molina Individual Corporate DirectorCoo Jan 23, 2023 50%
Thomas Meyers Individual Corporate DirectorCco Mar 26, 2018
Corporate OfficerChief Executive Officer Mar 27, 2018 50%
Dianne Moore Individual Corporate Director Jun 13, 2011
Corporate DirectorBoard Member May 27, 2015
Caldine Rey Individual Corporate Director Jun 13, 2011
Corporate DirectorBoard Member Jun 13, 2011
Corporate DirectorBoard Member May 27, 2015
Lawrence Wojcik Individual Corporate DirectorCfo Jun 8, 2021
Miriam Vega Dabbah Individual W-2 Managing EmployeeCeo Nov 18, 2019 100%
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
Patricia Gillespie Individual Corporate DirectorBoard Member May 14, 2014
Corporate DirectorBoard Member May 27, 2015
Sandy Fogg Individual Corporate DirectorCoo Jun 13, 2011
Saywalah Kesselly Individual Corporate DirectorBoard Member Jun 13, 2011
Corporate DirectorBoard Member May 27, 2015
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
Corporate DirectorBoard Member May 27, 2015
Alonzo Belgrave Individual Corporate DirectorBoard Member May 14, 2014
Glenn Greenidge Individual Corporate DirectorBoard Member May 14, 2014
Corporate DirectorBoard Member Jun 27, 2013
Merril Wright Individual Corporate DirectorBoard Member Jun 13, 2011
Samora Coles Individual Corporate DirectorBoard Member May 14, 2014
Saraswati Sahabir Individual Corporate OfficerCfo Dec 4, 2017
Elizabeth Blaney Individual Corporate DirectorBoard Member May 27, 2015
Beatrice Byrd Individual Corporate DirectorBoard Member May 27, 2015
Marie Gallant Individual W-2 Managing EmployeeMD; Oct 15, 2012 25%
Leonor Reina Individual Corporate DirectorBoard Member May 27, 2015
Danielle Johnson Individual Corporate DirectorBoard Member May 27, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1497700736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 BEACH CHANNEL DR",
            "city": "ARVERNE",
            "state": "NY",
            "postal_code": "116921409",
            "telephone_number": "718-945-7150",
            "fax_number": "718-945-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 BEACH CHANNEL DR",
            "city": "ARVERNE",
            "state": "NY",
            "postal_code": "116921409",
            "telephone_number": "718-945-7150",
            "fax_number": "718-942-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-08-15",
        "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": "009900152",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arverne, NY

Sources for this page

Verify at the official NPI Registry.