Healthcare Provider Details

I. General information

NPI: 1710535836
Provider Name (Legal Business Name): URBAN FAMILY DOCTOR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 OCEAN AVE # 1A
BROOKLYN NY
11225-4763
US

IV. Provider business mailing address

185 OCEAN AVE # 1A
BROOKLYN NY
11225-4763
US

V. Phone/Fax

Practice location:
  • Phone: 347-669-0017
  • Fax: 347-669-0016
Mailing address:
  • Phone: 347-669-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HARRIS
Title or Position: SOLE OWNER
Credential:
Phone: 347-669-0017