Healthcare Provider Details

I. General information

NPI: 1952562084
Provider Name (Legal Business Name): MICHAEL J URBAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 BROAD ST
ONEIDA NY
13421-2449
US

IV. Provider business mailing address

446 BROAD STREET
ONEIDA NY
13421
US

V. Phone/Fax

Practice location:
  • Phone: 315-264-3365
  • Fax: 240-209-8897
Mailing address:
  • Phone: 315-264-3365
  • Fax: 240-209-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6163047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: