NPIMap

Organization Active NPI

Newark Community Health Centers Inc

Doing business as Irvington Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Irvington, NJ
National Provider Identifier
1972778413
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
23134 Issued in NJ
Legal business name
NEWARK COMMUNITY HEALTH CENTERS INC
Doing business as
Irvington Community Health Center
Practice address
1150 Springfield Ave
Irvington, NJ 07111-2441
Phone
(973) 399-6292
Fax
(973) 372-4534
NPI assigned
Apr 25, 2008
Last updated
Apr 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NEWARK COMMUNITY HEALTH CENTERS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Authorized official

Name
Pamela Clarke, DOCTORATE
Title
President/Ceo
Phone
(973) 483-1300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Federally Qualified Health Center (FQHC) 261QF0400X 23134 NJ Primary

Addresses

Primary practice location

1150 Springfield Ave
Irvington, NJ 07111-2441

Mailing address

741 Broadway
Newark, NJ 07104-4309
Phone (973) 483-1300

Other identifiers 2

IdentifierTypeStateIssuer
0179965MedicaidNJ
23134OtherNJSTATE LICENSE

Other names 1

  • Irvington Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081027000240 NJ Part A Provider - Federally Qualified Health Center (FQHC) 2163334665 Practice locations: Irvington, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972778413. Details of each certification follow.

Federally qualified health center certification: CCN 311856

Legal name
NEWARK COMMUNITY HEALTH CENTERS INC
Doing business as
IRVINGTON COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 23, 2005
Last certification
Mar 23, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 23, 2005 in NJ
Enrollment address
1150 Springfield Ave
Irvington, NJ 71112441

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Newark Community Health Centers Inc7 organizations share this tax ID, including this one
Part of
Newark Community Health Centers Inc

Other organizations with this tax ID 6

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

Locations

1148 Springfield Ave
Irvington, NJ 07111
Phone (973) 399-6292

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Nicole a Waryn Individual W-2 Managing EmployeeManager of Billing and Patient Fina Oct 15, 2025
Haniel Rosemond Individual Corporate DirectorBoard Member Dec 18, 2023
W-2 Managing EmployeeBoard Member Dec 18, 2023
Arthur Nisbeth Individual Corporate Director Nov 10, 2022
Pamela Clarke Individual Corporate OfficerCeo Nov 1, 2010
W-2 Managing EmployeeCeo Nov 1, 2010
Jacqueline Mompoint Individual Corporate Director Nov 10, 2022
Edward Robinson Individual Corporate DirectorTreasurer Nov 10, 2022
Thomas M Ransome Individual Corporate DirectorBoard Member Dec 18, 2023
W-2 Managing EmployeeBoard Member Dec 18, 2023
Omar M Bey Individual Corporate OfficerCeo Nov 1, 2010
Corporate DirectorChair Jan 1, 2008
Yewande Efodili Individual Corporate DirectorDirector of Patient Financial SE Jun 17, 2025
W-2 Managing EmployeeDirector of Patient Financial Servi Jun 17, 2025
Patricia Vallejo Individual Corporate Director Nov 10, 2022
Cassandra Savoy Individual Corporate DirectorBoard Member May 1, 2023
W-2 Managing EmployeeBoard Member May 1, 2023
Alo Gold Individual Corporate Director Nov 10, 2022
Michael L Moore Individual Corporate OfficerBoard Member Nov 17, 2014
Temi Boyo Individual Corporate OfficerBoard Member May 1, 2025

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 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712880000000",
    "number": "1972778413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 BROADWAY",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071044309",
            "telephone_number": "973-483-1300",
            "fax_number": "973-483-3787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 SPRINGFIELD AVE",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071112441",
            "telephone_number": "973-399-6292",
            "fax_number": "973-372-4534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWARK COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEWARK COMMUNITY HEALTH CENTERS INC",
        "enumeration_date": "2008-04-25",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "973-483-1300",
        "authorized_official_credential": "DOCTORATE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "23134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0179965",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "23134",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Irvington Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Irvington Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvington, NJ

Sources for this page

Verify at the official NPI Registry.