NPIMap

Organization Active NPI

Joseph P. Addabbo Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
National Provider Identifier
1578810883
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
120 Richards Street
Brooklyn, NY 11231
Phone
(718) 945-7150
Fax
(718) 945-2596
NPI assigned
Aug 7, 2012
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, 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

120 Richards Street
Brooklyn, NY 11231

Mailing address

6200 Beach Channel Dr
Arverne, NY 11692-1409
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
O20151002000354 NY Part A Provider - Federally Qualified Health Center (FQHC) 0749174654 Practice locations: Brooklyn, 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

Federally qualified health center certification: CCN 331177

Legal name
JOSEPH P. ADDABBO FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 29, 2015
Last certification
Nov 29, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1987 in NY
Enrollment address
120 Richards St
Brooklyn, NY 11231-1635

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

6200 Beach Channel Dr
Arverne, NY 11692
Phone (718) 945-2400

6200 Beach Channel Dr
Fl 3
Arverne, NY 11692
Phone (929) 995-0733

6200 Beach Channel Dr
#312
Arverne, NY 11692

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Maria Imelda S Mamba Individual Corporate OfficerChief Financial Officer Feb 4, 2013
W-2 Managing EmployeeChief Financial Officer Feb 4, 2013
Camille Eaddy Individual Corporate DirectorBoard Member Sep 1, 2003
Sylvester Okonkwo Individual Corporate DirectorBoard Member Jun 1, 1997
Patricia Gillespie Individual Corporate DirectorBoard Member Apr 20, 2015
Elizabeth Blaney Individual Corporate DirectorBoard Member Feb 1, 2015
Sandy Fogg Individual Corporate OfficerChief Operating Officer Jan 22, 1985
W-2 Managing EmployeeChief Operating Officer Jan 22, 1985
Beatrice Byrd Individual Corporate DirectorBoard Member Aug 1, 2012
Saywalah Kesselly Individual Corporate DirectorBoard Member Jan 1, 2010
Betty Leon Individual Corporate DirectorBoard Member Jun 1, 2000
Leonor Reina Individual Corporate DirectorBoard Member Feb 1, 2015
Sandria de Ackbersingh-Twitty Individual Corporate DirectorBoard Member Feb 1, 2015
Danielle Johnson Individual Corporate DirectorBoard Member Feb 1, 2015
Glenn Greenidge Individual Corporate DirectorBoard Member Jun 27, 2013
Dianne Moore Individual Corporate DirectorBoard Member Jun 1, 1995
Caldine Rey Individual Corporate DirectorBoard Member Feb 1, 2010
Lawrence Wojcik Individual Corporate OfficerCfo Jun 8, 2021
W-2 Managing EmployeeCfo Jun 8, 2021
Miriam Vega Dabbah Individual W-2 Managing EmployeeCeo Nov 18, 2019

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1578810883",
    "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": "120 RICHARDS STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11231",
            "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": "2012-08-07",
        "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 Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.