Provider Demographics
NPI:1679945760
Name:HENRY J. AUSTIN HEALTH CENTER, INC.
Entity type:Organization
Organization Name:HENRY J. AUSTIN HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-278-5900
Mailing Address - Street 1:314-316 EAST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08608-1810
Mailing Address - Country:US
Mailing Address - Phone:609-278-5900
Mailing Address - Fax:609-392-4827
Practice Address - Street 1:314-316 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1810
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:609-392-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)