Active NPI
Icl Healthcare Choices Inc
- Federally Qualified Health Center (FQHC)
- Brooklyn, NY
National Provider Identifier
1770011314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- License
- 7001299R
- Legal business name
- ICL HEALTHCARE CHOICES INC
- Practice address
- 179 Jamaica Ave
Brooklyn, NY 11207-2049 - Phone
- (929) 267-5354
- Fax
- (929) 267-5340
- NPI assigned
- May 26, 2017
- Last updated
- Jul 21, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Maria Siebel, LCSW
- Title
- Ceo
- Phone
- (718) 234-0073
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 7001299R | NY | Primary |
Addresses
Primary practice location
179 Jamaica Ave
Brooklyn, NY 11207-2049
Mailing address
6209 16TH Ave
Brooklyn, NY 11204-2702
Phone (718) 234-0073
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02186390 | Medicaid | NY | |
| W86751 | Other | NY | PART B |
National Provider Directory
National Provider Directory- Tax ID family
- Icl Healthcare Choices Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Federally Qualified Health Center (FQHC)
- Brooklyn, NY
- NPI 1770521270
-
- Federally Qualified Health Center (FQHC)
- Brooklyn, NY
- NPI 1649733320
-
- Federally Qualified Health Center (FQHC)
- Long Island City, NY
- NPI 1215465851
Locations
179 Jamaica Ave
Brooklyn, NY 11207
Phone (718) 906-3800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495756800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1770011314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6209 16TH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112042702",
"telephone_number": "718-234-0073",
"fax_number": "718-236-8456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 JAMAICA AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112072049",
"telephone_number": "929-267-5354",
"fax_number": "929-267-5340"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ICL HEALTHCARE CHOICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2017-05-26",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "SIEBEL",
"authorized_official_first_name": "MARIA",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "718-234-0073",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "NY",
"license": "7001299R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02186390",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PART B",
"identifier": "W86751",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.