City of Newark

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CITY OF NEWARK

Doing business as

Newark Department of Health and Community Wellness/Mary Eliza Mahoney

Practice address

701 South Orange Avenue
Newark, NJ 07106-2209

Phone

(800) 734-7083

NPI assigned

Mar 24, 2023

Last updated

Apr 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ketlen Alsbrook

Title

Ceo & Director

Phone

(973) 733-5310

Specialties & licenses 1

Addresses

Other names 1

• Newark Department of Health and Community Wellness/Mary Eliza Mahoney Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972206258. Details of each certification follow.

• CCN 311011 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 311011

Legal name

CITY OF NEWARK

Doing business as

NEWARK DEPARTMENT OF HEALTH AND COMMUNITY WELLNESS MARY ELIZA MAHONEY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 5, 2024

Last certification

Jun 5, 2024

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

701 South Orange Avenue
Newark, NJ 71061300

Other NPIs with the same Medicare PAC ID 3

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

• City of Newark

  dba Newark Department of Health and Community Welllness

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1295958908

  8123169182

  Same PAC ID
• City of Newark

  dba Newark Department of Health and Community Wellness

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1356561278

  8123169182

  Same PAC ID
• City of Newark

  dba Newark Department of Health and Community Wellness

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1376976704

  8123169182

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• City of Newark

  dba Newark Department of Health and Community Wellness

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1356561278

  O20100113000101

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Dept Health and Human S14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

• City of Newark

  dba Newark Dept of Health and Community Wellness Dental Mobile Unit

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1104647635
  NPD tax ID
• City of Newark

  dba Newark Dept of Health/Mary Eliza Mahoney Hlth Ctr Mobile Unit #1

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1174362420
  NPD tax ID
• City of Newark

  dba Newark Department of Health and Community Welllness

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1295958908
  NPD tax ID
• City of Newark

  dba Newark Department of Health and Community Wellness

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1356561278
  NPD tax ID
• City of Newark

  dba Newark Department of Health and Community Wellness

  • Community Health Clinic/Center
  • Newark, NJ
  • NPI 1376976704
  NPD tax ID
• City of Newark

  dba City of Newark/Dept of Health

  • Public Health or Welfare Agency
  • Newark, NJ
  • NPI 1427467034
  NPD tax ID
• City of Newark

  dba Newark Dept of Health & Community Wellness- BC

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1477914612
  NPD tax ID
• City of Newark

  dba Newark Department of Health and Community Wellness - Mobile Van Unit

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1548678303
  NPD tax ID
• City of Newark

  dba Newark Dept of Health/Mary Eliza Mahoney Hlth Ctr Mobile Unit #3

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1699514943
  NPD tax ID
• City of Newark

  dba Newark Department of Health & Community Wellness- Women's Health Ctr

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1720539620
  NPD tax ID
• City of Newark

  dba Newark Dept of Hlth & Comm Wellness-Dental Mary Eliza Mahoney Hlth Ctr

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1851757645
  NPD tax ID
• City of Newark

  dba Newark Department of Health/Mary Eliza Mahoney Hlth Ctr Mobile Unit #2

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1942059506
  NPD tax ID

Locations

All disclosed owners & managing parties 8

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

Practitioners 24

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.

• Emmanuel O Anyanwu, APN

  • Psychiatric/Mental Health Nurse Practitioner
  • Livingston, NJ
  • NPI 1912417130
  NPD
• Maria P Boyle, M.D,

  • Pediatrics Physician
  • North Arlington, NJ
  • NPI 1083758775
  NPD
• Vincent Davidson Carrington, DENTIST DDS

  • Dentist
  • Newark, NJ
  • NPI 1316130164
  NPD
• Victoria Caulcrick, DNP/ APN

  • Adult Health Nurse Practitioner
  • Newark, NJ
  • NPI 1982053740
  NPD
• Philomena Ifeyinwa Chinemelu, APN

  • Family Nurse Practitioner
  • Somerset, NJ
  • NPI 1013222637
  NPD
• Martine Clervil, FNP-C

  • Family Nurse Practitioner
  • Newark, NJ
  • NPI 1386367449
  NPD
• Ndidiamaka Ezuma, APN

  • Family Nurse Practitioner
  • Newark, NJ
  • NPI 1881287829

  Single Specialty

  NPD
• Wanda E. Figueroa, M.D.

  • Infectious Disease Physician
  • Newark, NJ
  • NPI 1194811463
  NPD
• Regina N Inokon

  • Psychiatric/Mental Health Nurse Practitioner
  • Newark, NJ
  • NPI 1982210969
  NPD
• Irene Kathuria, D.D.S.

  • General Practice Dentistry
  • Perth Amboy, NJ
  • NPI 1912200171
  NPD
• Feminia Castro Mac, MD

  • Pediatric Adolescent Medicine Physician
  • Newark, NJ
  • NPI 1942386966
  NPD
• Baseemah Marshall, DMD

  • General Practice Dentistry
  • Perth Amboy, NJ
  • NPI 1891137782
  NPD

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1972206258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WILLIAM ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021304",
            "telephone_number": "973-424-4271",
            "fax_number": "973-353-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SOUTH ORANGE AVENUE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071062209",
            "telephone_number": "800-734-7083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF NEWARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2024-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "ALSBROOK",
        "authorized_official_first_name": "KETLEN",
        "authorized_official_title_or_position": "CEO & DIRECTOR",
        "authorized_official_telephone_number": "973-733-5310"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newark Department of Health and Community Wellness/Mary Eliza Mahoney",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Newark (Newark Department of Health and Community Wellness - Mobile Van Unit)
• City of Newark (Newark Dept of Health/Mary Eliza Mahoney Hlth Ctr Mobile Unit #3)
• City of Newark (Newark Department of Health & Community Wellness- Women's Health Ctr)
• City of Newark (Newark Dept of Hlth & Comm Wellness-Dental Mary Eliza Mahoney Hlth Ctr)
• City of Newark (Newark Department of Health/Mary Eliza Mahoney Hlth Ctr Mobile Unit #2)
• City of Newark Dept of Child and Family Well Being Mobile Medical Van
• Citylife Clinics NJ, PC
• CJM Medical Transportation Services
• Clarendon Gardens Social Center
• Harrison James Clark, MD

• Federally Qualified Health Center (FQHC) in Newark, NJ
• Providers in Newark, NJ by specialty
• Federally Qualified Health Center (FQHC) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.