Healthcare Provider Details

I. General information

NPI: 1568518611
Provider Name (Legal Business Name): URBAN HEALTH PLAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SOUTHERN BOULEVARD
BRONX NY
10460-5980
US

IV. Provider business mailing address

1065 SOUTHERN BLVD
BRONX NY
10459-2417
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-2440
  • Fax: 718-589-4793
Mailing address:
  • Phone: 718-589-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. SAMUEL DELEON
Title or Position: CMO/VP MEDICAL AFFAIRS
Credential: MD
Phone: 718-589-2440