Under 21
NPI 1053588988ActiveOrganization· Clinic/Center· New York, NY
Clinic/Center in New York, New York, registered in NPPES in May 2008. The authorized official on file is David J. Davis, D.O., Medical Director. Enrolled in Medicare as part a provider - federally qualified health center (fqhc) and part b supplier - clinic/group practice.
Overview
| NPI | 1053588988 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 9, 2008 |
| Last updated in NPPES | Jun 9, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center Primary | 261Q00000X | — | — |
| Clinic/Center, Federally Qualified Health Center (FQHC) | 261QF0400X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part A Provider - Federally Qualified Health Center (FQHC) (NY); Part B Supplier - Clinic/Group Practice (NY) |
|---|
Other Clinic/Center providers in New York
- 1528502952
- 1003194275
- 1013331594
- 1023675816
- 1033123039
- 1033924287
- 1043662240
- 1053020818
- 1053232256
- 1063103984
- 1063232353
- 1063644714
All 190 Clinic/Center providers in New York · All Clinic/Center providers in New York