Provider Demographics
NPI:1750987566
Name:URBAN LIGHT PSYCHIATRIC NP PLLC
Entity type:Organization
Organization Name:URBAN LIGHT PSYCHIATRIC NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:AFFUL
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:347-543-4726
Mailing Address - Street 1:180 S BROADWAY STE 406
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1820
Mailing Address - Country:US
Mailing Address - Phone:347-543-4726
Mailing Address - Fax:914-222-8921
Practice Address - Street 1:180 S BROADWAY STE 406
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1820
Practice Address - Country:US
Practice Address - Phone:347-543-4726
Practice Address - Fax:914-222-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05993242Medicaid