Provider Demographics
NPI:1730487034
Name:URBAN HEALTH PLAN, INC
Entity Type:Organization
Organization Name:URBAN HEALTH PLAN, INC
Other - Org Name:PS 75 - SCHOOL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CMO MEDICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-589-2440
Mailing Address - Street 1:1065 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2417
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:984 FAILE ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3703
Practice Address - Country:US
Practice Address - Phone:718-958-9244
Practice Address - Fax:718-991-4516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PS 75 - SCHOOL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-10
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994952Medicaid
NY131885Medicare Oscar/Certification