Healthcare Provider Details

I. General information

NPI: 1437570256
Provider Name (Legal Business Name): URBAN MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MOTT ST SUITE 202
NEW YORK NY
10013-5540
US

IV. Provider business mailing address

128 MOTT ST SUITE 202
NEW YORK NY
10013-5540
US

V. Phone/Fax

Practice location:
  • Phone: 646-355-3711
  • Fax: 212-300-4989
Mailing address:
  • Phone: 646-355-3711
  • Fax: 212-300-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY JOHNSON
Title or Position: MD
Credential: MD
Phone: 646-355-3711