Basic Information
| Provider Information | |||||||||
| NPI: | 1477980845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENRY J AUSTIN HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 N WARREN STREET | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092785900 | ||||||||
| FaxNumber: | 6096953532 | ||||||||
| Practice Location | |||||||||
| Address1: | 433 BELLEVUE AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092785900 | ||||||||
| FaxNumber: | 6096953532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2013 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | ALLI | ||||||||
| AuthorizedOfficialFirstName: | KEMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 6092786012 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | NJ | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.