Healthcare Provider Details

I. General information

NPI: 1750987566
Provider Name (Legal Business Name): URBAN LIGHT PSYCHIATRIC NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S BROADWAY STE 406
WHITE PLAINS NY
10605-1820
US

IV. Provider business mailing address

180 S BROADWAY STE 406
WHITE PLAINS NY
10605-1820
US

V. Phone/Fax

Practice location:
  • Phone: 347-543-4726
  • Fax: 914-222-8921
Mailing address:
  • Phone: 347-543-4726
  • Fax: 914-222-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD K AFFUL
Title or Position: MANAGER
Credential: NPP
Phone: 347-543-4726