Provider Demographics
NPI:1710125141
Name:URBAN HEALTH PLAN, INC.
Entity Type:Organization
Organization Name:URBAN HEALTH PLAN, INC.
Other - Org Name:PLAZA DEL SOL FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO/VP MEDICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-589-2440
Mailing Address - Street 1:3716 108TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2025
Mailing Address - Country:US
Mailing Address - Phone:718-651-4000
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:3716 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2025
Practice Address - Country:US
Practice Address - Phone:718-651-4000
Practice Address - Fax:718-991-4516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAZA DEL SOL FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244977Medicaid
NY331885Medicare Oscar/Certification