Provider Demographics
NPI:1538358932
Name:NEW YORK URBAN LEAGUE
Entity type:Organization
Organization Name:NEW YORK URBAN LEAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-485-9660
Mailing Address - Street 1:444 THOMAS BOYLAND STREET
Mailing Address - Street 2:ROOM 207
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:718-485-9660
Mailing Address - Fax:718-385-7545
Practice Address - Street 1:444 THOMAS S BOYLAND ST
Practice Address - Street 2:ROOM 207
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5042
Practice Address - Country:US
Practice Address - Phone:718-485-9660
Practice Address - Fax:718-385-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01133302Medicaid