Healthcare Provider Details

I. General information

NPI: 1871833970
Provider Name (Legal Business Name): URBAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MARTIN LUTHER KING JR DR
JERSEY CITY NJ
07305-3025
US

IV. Provider business mailing address

95 MARTIN LUTHER KING JR DR
JERSEY CITY NJ
07305-3025
US

V. Phone/Fax

Practice location:
  • Phone: 201-332-7077
  • Fax: 201-332-7003
Mailing address:
  • Phone: 201-332-7077
  • Fax: 201-332-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00418900
License Number StateNJ

VIII. Authorized Official

Name: DR. HYACINTH UCHEAGWU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-332-7077