Healthcare Provider Details

I. General information

NPI: 1558899260
Provider Name (Legal Business Name): URBAN LUXURY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 IRVING AVE STE 2
RIDGEWOOD NY
11385-5302
US

IV. Provider business mailing address

9302 75TH STREET 1
WOODHAVEN NY
11421
US

V. Phone/Fax

Practice location:
  • Phone: 718-200-2022
  • Fax:
Mailing address:
  • Phone: 718-503-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberB03025
License Number StateNY

VIII. Authorized Official

Name: JOEL H PENA
Title or Position: PRESIDENT
Credential:
Phone: 718-503-1155