Healthcare Provider Details

I. General information

NPI: 1518179142
Provider Name (Legal Business Name): UCP OF NYC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 149TH ST APT # 4C
BRONX NY
10451-5516
US

IV. Provider business mailing address

1922 MCGRAW AVE APT# 6B
BRONX NY
10462-7974
US

V. Phone/Fax

Practice location:
  • Phone: 718-993-2710
  • Fax:
Mailing address:
  • Phone: 718-792-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number365115
License Number StateNY

VIII. Authorized Official

Name: MS. DOROTHY JONES
Title or Position: RESIDENTIAL NURSE
Credential: RN
Phone: 718-993-2710