Provider Demographics
NPI:1336512144
Name:URBAN, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:URBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 VANTAGE POINT DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1180
Mailing Address - Country:US
Mailing Address - Phone:585-352-7775
Mailing Address - Fax:585-352-7879
Practice Address - Street 1:50 VANTAGE POINT DR STE 4
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1180
Practice Address - Country:US
Practice Address - Phone:585-352-7775
Practice Address - Fax:585-352-7879
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator