| NPI | 1295218196 |
|---|---|
| Other Name | CHURCH AVENUE CLINIC |
| Entity Type | Organization |
| Authorized Contact | ADAM K. LIPTON VP Info/Practice Mgmt Systems 914-384-2375 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NY 5901200R) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2022-03-14 |