Provider Demographics
NPI:1700222353
Name:URBAN NEW YORK MEDICAL PC
Entity Type:Organization
Organization Name:URBAN NEW YORK MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:718-360-0907
Mailing Address - Street 1:PO BOX 720507
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-0507
Mailing Address - Country:US
Mailing Address - Phone:718-360-0907
Mailing Address - Fax:
Practice Address - Street 1:2818 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3349
Practice Address - Country:US
Practice Address - Phone:718-360-0907
Practice Address - Fax:313-281-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400065666OtherMEDICARE
NY02667581Medicaid