Healthcare Provider Details

I. General information

NPI: 1376855940
Provider Name (Legal Business Name): URBAN PSYCHIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2010
Last Update Date: 07/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2467 OCEAN AVE
BROOKLYN NY
11229-3969
US

IV. Provider business mailing address

2467 OCEAN AVE
BROOKLYN NY
11229-3969
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-8686
  • Fax: 718-891-7911
Mailing address:
  • Phone: 718-891-8686
  • Fax: 718-891-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELCHIN GAJIEV
Title or Position: PRESIDENT
Credential: M.D., D.O.
Phone: 718-290-6541