Provider Demographics
NPI:1144764069
Name:URGENTWAY MEDICINE, PLLC
Entity type:Organization
Organization Name:URGENTWAY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-213-0190
Mailing Address - Street 1:535 8TH AVENUE, 37TH ST, 6 FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4305
Mailing Address - Country:US
Mailing Address - Phone:646-213-0190
Mailing Address - Fax:646-381-2269
Practice Address - Street 1:535 8TH AVENUE, 37TH ST, 6 FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4305
Practice Address - Country:US
Practice Address - Phone:646-213-0190
Practice Address - Fax:646-381-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05047512Medicaid