Healthcare Provider Details

I. General information

NPI: 1861889073
Provider Name (Legal Business Name): URBNDESIGNZ GRAPHICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NEWBROOK LN
BAY SHORE NY
11706-4416
US

IV. Provider business mailing address

15 NEWBROOK LN
BAY SHORE NY
11706-4416
US

V. Phone/Fax

Practice location:
  • Phone: 631-833-8527
  • Fax: 631-504-0299
Mailing address:
  • Phone: 631-833-8527
  • Fax: 631-504-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number272506
License Number StateNY

VIII. Authorized Official

Name: DOMINIQUE HAMILTON
Title or Position: CEO
Credential:
Phone: 631-894-7761