Healthcare Provider Details

I. General information

NPI: 1154408136
Provider Name (Legal Business Name): JAMES R URGO NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE STE B
DUNKIRK NY
14048-2125
US

IV. Provider business mailing address

319 CENTRAL AVE STE B
DUNKIRK NY
14048-2137
US

V. Phone/Fax

Practice location:
  • Phone: 716-363-6050
  • Fax:
Mailing address:
  • Phone: 716-363-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number333263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: