Provider Demographics
NPI:1770847014
Name:URBAN HEALTH PLAN, INC
Entity Type:Organization
Organization Name:URBAN HEALTH PLAN, INC
Other - Org Name:PENINSULA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORBON
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:1967 TURNBULL AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2519
Practice Address - Country:US
Practice Address - Phone:718-684-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URBAN HEATLH PLAN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-02
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331885Medicare Oscar/Certification