Organization Name: | OPEN DOOR FAMILY MEDICAL CENTER SCHOOL BASED MOBILE DENTAL VAN |
NPI Number: | 1073919973 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIA MAZZOTTA (CFO) |
Mailing Address: | 165 Main St Ossining |
State: | NY US |
Postal Code: | 105624702 |
Phone Number: | 9149411263 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2014 |
NPI Last Update Date: | 11/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 5905200R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |