Healthcare Provider Details

I. General information

NPI: 1497576946
Provider Name (Legal Business Name): URBANE CARE NP, NURSE PRACTITIONER IN FAMILY HEALTH, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SOUTH AVENUE 2ND FLOOR, EX SUITES, SUITE 125
STATEN ISLAND NY
10303
US

IV. Provider business mailing address

42 AMITY PL
STATEN ISLAND NY
10303-1713
US

V. Phone/Fax

Practice location:
  • Phone: 929-367-0510
  • Fax: 929-367-0511
Mailing address:
  • Phone: 929-367-0510
  • Fax: 929-367-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMOTARA ADEWALE
Title or Position: FAMILY HEALTH NURSE PRACTITIONER
Credential: DNP, NP-C, FNP-BC
Phone: 646-465-4656