MEDICARE: URBAN HEALTH PLAN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1386247542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN HEALTH PLAN, INC.

Provider Business Mailing Address
First Line	:	858-866 EAST TREAMONT AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	858-866 EAST TREAMONT AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-1046
Country	:	US
Telephone Number	:	718-589-2440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	PALOMA HERNANDEZ
Credential	:	PHD
Telephone Number	:	718-589-2440

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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