NPIMap

Organization Active NPI

North Hudson Community Action Corporation

  • Federally Qualified Health Center (FQHC)
  • West New York, NJ
National Provider Identifier
1659323442
Registry record updated May 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Practice address
5301 Broadway
West New York, NJ 07093-2622
Phone
(201) 866-9320
Fax
(201) 392-9084
NPI assigned
May 17, 2006
Last updated
May 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2013

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

Authorized official

Name
Mr. Michael Shababb
Title
Interim President/Ceo
Phone
(201) 866-2388

Specialties & licenses 1

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

Addresses

Primary practice location

5301 Broadway
West New York, NJ 07093-2622

Mailing address

800 31St St
Union City, NJ 07087-2428
Phone (201) 210-0100

Other identifiers 1

IdentifierTypeStateIssuer
0022705MedicaidNJ

Other names 1

  • Mobile Van Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20041025000939 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jersey City, NJ
O20061013000393 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Garfield, NJ
O20080528000175 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Passaic, NJ
O20080909000683 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hackensack, NJ
O20081208000669 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 Practice locations: West New York, NJ

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1659323442. Details of each certification follow.

Federally qualified health center certification: CCN 311848

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 29, 2004
Last certification
Dec 29, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in NJ
Enrollment address
324 Palisade Ave
Jersey City, NJ 73071791
Related CCNs
311829

Federally qualified health center certification: CCN 311868

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Doing business as
N/A
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 4, 2006
Last certification
Dec 4, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationProprietary
Incorporated
Oct 29, 1965 in NJ
Enrollment address
535 Midland Ave
Garfield, NJ 70261658

Federally qualified health center certification: CCN 311882

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 15, 2008
Last certification
Jul 15, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in NJ
Enrollment address
220 Passaic St
Passaic, NJ 70556400

Federally qualified health center certification: CCN 311886

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 24, 2008
Last certification
Sep 24, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in NJ
Enrollment address
25E Salem St
Hackensack, NJ 76017427

Federally qualified health center certification: CCN 311829

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 3, 1994
Last certification
Jan 3, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in NJ
Enrollment address
5301 Broadway
West New York, NJ 70932622

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

800 31st St
Union City, NJ 07087
Phone (201) 201-0100

Ownership & related parties

All disclosed owners & managing parties 41

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

NameRoleSinceShare
Pura Cabrera Individual Corporate DirectorBoard Member Jul 31, 2013
Juana Malave Individual Corporate DirectorBoard Member Jan 20, 2015
Joseph Muniz Individual Corporate DirectorBoard Member, Chairperson Apr 25, 2011
Corporate DirectorBoard Member-Chairperson Apr 25, 2011
Corporate DirectorBoard Member - Chairperson Apr 25, 2011
Corporate DirectorBoard Member Chairperson Apr 25, 2011
Maria Vila Individual Corporate DirectorBoard Member Jul 31, 2013
Michael Shababb Individual Corporate OfficerCfo Jul 1, 1994
W-2 Managing EmployeeCfo Jul 1, 1994
Corporate OfficerCfo Nov 17, 2006
Corporate Director Nov 17, 2006
W-2 Managing Employee Nov 17, 2006
W-2 Managing EmployeeCfo Nov 18, 2014
W-2 Managing EmployeeCfo Feb 10, 2015
W-2 Managing EmployeeCfo Jan 1, 2006
Joan Quigley Individual Corporate OfficerCeo Jul 1, 2013
W-2 Managing EmployeeCeo Feb 27, 2015
W-2 Managing EmployeeCeo Nov 18, 2014
W-2 Managing EmployeeCeo Feb 10, 2015
W-2 Managing EmployeeCeo Feb 6, 2015
Silverio Vega Individual Corporate DirectorBoard Member Sep 16, 2014
Kim Nicoliello Individual Corporate DirectorBoard Member Mar 18, 2014
Christina McLellan Individual Corporate DirectorBoard Member Nov 28, 2013
Marisol Acosta Individual Corporate DirectorBoard Member Oct 29, 2012
Corporate Director Oct 29, 2012
Robert Divincent Individual Corporate DirectorBoard Member Sep 16, 2014
Corporate Director Nov 9, 2006
Corporate Director May 12, 2008
Victor Grullon Individual Corporate DirectorBoard Memeber Dec 16, 2013
Corporate DirectorBoard Member Dec 16, 2013
Wayne Cook Individual Corporate DirectorBoard Member Oct 31, 2014
Hilda R Roque Dieguez Individual Corporate DirectorBoard Member Oct 31, 2011
Linda Habermann Individual Corporate DirectorBoard Member Mar 18, 2014
Oscar Lanza Individual Corporate Director Nov 9, 2006
Ganga Rastogi Individual Corporate Director Apr 15, 2009
Yousef Abdallah Individual Corporate Director Nov 9, 2006
Maria Almeida Individual Corporate Director Nov 9, 2006
Juan Antonio Villalobos Individual Corporate Director Apr 15, 2009
Paul Valdivia Individual Corporate Director Apr 15, 2009
David Krusznis Individual Corporate Director Apr 15, 2009
Erika Zucconi Individual Corporate Director Apr 15, 2009
Corporate DirectorBoard Member-1St Vice Chairperso May 12, 2008
Corporate DirectorBoard Member - 1St Vice Chairper Dec 18, 2006
Corporate DirectorBoard Member 1St Vice Chairperso Dec 18, 2006
Altagracia Gutierrez Individual Corporate Director Nov 28, 2006
Hansel Asmar Individual Corporate Director Apr 15, 2009
Joanne Martin Individual Corporate Director Nov 9, 2006
Lizaida Ortega Individual Corporate Director Apr 15, 2009
Mary Ocasio Individual Corporate Director Nov 9, 2006
Maria Cainas Individual Corporate Director Nov 9, 2006
Barbara Phillips Individual Corporate Director Apr 15, 2009
Annia Cabrera Individual Corporate Director Jun 9, 2009
Richard Dwyer Individual Corporate Director Nov 9, 2006
Steven Smith Individual Corporate Director Nov 9, 2006
Nadia Cabana Individual Corporate Director Apr 15, 2009
Richard Censullo Individual Corporate Director Nov 9, 2006
Deanine Muniz Individual Corporate Director Apr 15, 2009
Joan Woods Individual Corporate DirectorBoard Member-Secretary Mar 4, 2013
Corporate DirectorBoard Member - Secretary Mar 4, 2013
Corporate DirectorBoard Member Secretary Mar 4, 2013
Mariano Pellegrino Individual Corporate DirectorBoard Member Jul 30, 2012
Lisa Snedeker Individual Corporate DirectorBoard Member Feb 24, 2015
Ulysses Isa Individual Corporate DirectorBoard Member Jun 29, 2009
Rosemary Roque Individual Corporate DirectorBoard Member Nov 29, 2010

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
North Hudson Community Action CorporationHarrison, NJ, CCN 311931 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2016
Feb 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1659323442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 31ST ST",
            "city": "UNION CITY",
            "state": "NJ",
            "postal_code": "070872428",
            "telephone_number": "201-210-0100",
            "fax_number": "201-348-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 BROADWAY",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070932622",
            "telephone_number": "201-866-9320",
            "fax_number": "201-392-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH HUDSON COMMUNITY ACTION CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "SHABABB",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "INTERIM PRESIDENT/CEO",
        "authorized_official_telephone_number": "201-866-2388",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0022705",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Van",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West New York, NJ

Sources for this page

Verify at the official NPI Registry.