Organization · Type 2 NPI

Nycdohmh Motthyn Connect CMCM

Community Health Clinic/Center · Bronx, NY

NPI number 1104872506 Active

Practice location

1309 Fulton Avenue, Nycdohmh Mott Haven Connect Cmcm
Bronx, NY 10456-2403

Call (718) 367-2450 Map

Fax (718) 367-5112

Mailing address

125 Worth Street, Nycdohmh Div Of Disease Control Rm 901 Box 22
New York, NY 10004-4006

Specialties and licenses

Taxonomy	Code	License
Community Health Clinic/Center Primary	261QC1500X	01234413026 (NY)

Community Health Clinic/Center: Definition to come...

Another provider at this address

City of New York Office of Payroll AdministrationState or Local Public Health Clinic/Center Bronx, NY NPI 1811925605

Other community health clinic/center providers in Bronx

See all in Bronx →

NPI record

NPI: 1104872506
Entity type: Organization (Type 2)
Issued: May 26, 2006
Last updated: Aug 22, 2020
Status: Active

Other names

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Nyc Dept of Health & Mental Hygiene Mott Haven Connect CMCM · other name

Authorized official

Mr. Michael James Smook, MPA
Administrative MGR 3d Party Revenue
(212) 442-5468

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104872506

Nycdohmh Motthyn Connect CMCM's National Provider Identifier is 1104872506, issued on May 26, 2006. The primary taxonomy on file is Community Health Clinic/Center (261QC1500X), and the practice location is in Bronx, NY. The record was last updated on Aug 22, 2020.