NPIMap

Organization Active NPI

Metropolitan Family Health Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • West New York, NJ
National Provider Identifier
1780892406
Registry record updated Apr 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
24088 Issued in NJ
Legal business name
METROPOLITAN FAMILY HEALTH NETWORK, INC.
Practice address
5300 Bergenline Ave
West New York, NJ 07093-5616
Phone
(201) 478-5800
Fax
(201) 478-5814
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2009

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

Authorized official

Name
Ms. Joan Dublin, RN, BSN, MPA
Title
Ceo
Phone
(201) 478-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 24088 NJ Primary

Addresses

Primary practice location

5300 Bergenline Ave
West New York, NJ 07093-5616

Mailing address

5300 Bergenline Ave
West New York, NJ 07093-5616
Phone (201) 478-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060913000533 NJ Part A Provider - Federally Qualified Health Center (FQHC) 4981608486 Practice locations: Jersey City, NJ
O20070907000455 NJ Part B Supplier - Clinic/Group Practice 4981608486 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jersey City, NJ; West New York, NJ

Federally qualified health center certification: CCN 311877

Legal name
METROPOLITAN FAMILY HEALTH NETWORK,INC
Doing business as
METROPOLITAN FAMILY HEALTH NETWORK,INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 19, 2007
Last certification
Oct 19, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
May 17, 2006 in NJ
Enrollment address
935 Garfield Ave
FL 3
Jersey City, NJ 73042731

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

5300 Bergenline Ave
West New York, NJ 07093
Phone (201) 478-5800

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Lilia Diaz Individual Operational/Managerial ControlBoard Member Feb 10, 2014 1%
Virginia Policarpio Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2006
Letia Nalls Individual Operational/Managerial ControlBoard Member Sep 9, 2022
Patrick D Beaty Individual Corporate Director Sep 1, 2006
W-2 Managing Employee Sep 1, 2006
Metropolitan Family Health Network,Inc Organization, Jersey City, NJ Non-profit Other Sep 1, 2006 100%
Douglas Scott Carey Individual W-2 Managing EmployeeAd; Apr 1, 2008
Joan M Dublin Individual Corporate Director Sep 4, 2007
W-2 Managing EmployeeAd; Sep 4, 2007

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239235200000",
    "number": "1780892406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 BERGENLINE AVE",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070935616",
            "telephone_number": "201-478-5800",
            "fax_number": "201-478-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 BERGENLINE AVE",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070935616",
            "telephone_number": "201-478-5800",
            "fax_number": "201-478-5814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROPOLITAN FAMILY HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2009-04-09",
        "status": "A",
        "authorized_official_last_name": "DUBLIN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "201-478-5800",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, BSN, MPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "24088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West New York, NJ

Sources for this page

Verify at the official NPI Registry.