NPIMap

Organization Active NPI

Heritage Health and Housing, Inc

  • Federally Qualified Health Center (FQHC)
  • New York, NY
National Provider Identifier
1851414965
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7002113R Issued in NY
Legal business name
HERITAGE HEALTH AND HOUSING, INC
Practice address
1727 Amsterdam Ave
4TH Floor
New York, NY 10031-4611
Phone
(212) 862-0054
Fax
(212) 862-5516
NPI assigned
Apr 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Authorized official

Name
Dr. Alvaro Jose Simmons, PHDNPI 1780982090
Title
Ceo
Phone
(212) 862-0054

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 7002113R NY
Federally Qualified Health Center (FQHC) 261QF0400X 7002113R NY Primary

Addresses

Primary practice location

1727 Amsterdam Ave
4TH Floor
New York, NY 10031-4611

Mailing address

1727 Amsterdam Ave
4TH Floor
New York, NY 10031-4611
Phone (212) 862-0054

Other identifiers 1

IdentifierTypeStateIssuer
00509980MedicaidNY

Other names 1

  • n/a Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030226000011 NY Part A Provider - Federally Qualified Health Center (FQHC) 2163331620 Practice locations: New York, NY

Federally qualified health center certification: CCN 331909

Legal name
HERITAGE HEALTH AND HOUSING, INC.
Doing business as
HERITAGE HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 8, 2003
Last certification
Apr 8, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1969 in NY
Enrollment address
1727 Amsterdam Ave
FL 4
New York, NY 10031-4611

National Provider Directory

National Provider Directory

Locations

1727 Amsterdam Ave
Fl 4
New York, NY 10031
Phone (212) 862-0054

1727 Amsterdam Ave
Fl Fourth
New York, NY 10031
Phone (212) 862-0054

1727 Amsterdam Ave
#4
New York, NY 10031
Phone (212) 862-0054

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Douglas B Blomberg Individual Corporate OfficerChief Financial Officer Oct 31, 2018 100%
W-2 Managing EmployeeChief Financial Officer Oct 31, 2018 100%

Practitioners & affiliated clinicians

Practitioners 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1851414965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 AMSTERDAM AVE",
            "address_2": "4TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100314611",
            "telephone_number": "212-862-0054",
            "fax_number": "212-862-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 AMSTERDAM AVE",
            "address_2": "4TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100314611",
            "telephone_number": "212-862-0054",
            "fax_number": "212-862-5516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE HEALTH AND HOUSING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "ALVARO",
        "authorized_official_middle_name": "JOSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "212-862-0054",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "7002113R",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7002113R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00509980",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "n/a",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.