Healthcare Provider Details

I. General information

NPI: 1396102059
Provider Name (Legal Business Name): URBAN BEHAVIORAL HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 MARTIN LUTHER KING JR DR
JERSEY CITY NJ
07304-2210
US

IV. Provider business mailing address

424 MARTIN LUTHER KING JR DR
JERSEY CITY NJ
07304-2210
US

V. Phone/Fax

Practice location:
  • Phone: 201-898-3610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GLORIA WALTON
Title or Position: OWNER
Credential:
Phone: 201-898-3610