Provider Demographics
NPI:1710535836
Name:URBAN FAMILY DOCTOR, PLLC
Entity type:Organization
Organization Name:URBAN FAMILY DOCTOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-669-0017
Mailing Address - Street 1:185 OCEAN AVE # 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4763
Mailing Address - Country:US
Mailing Address - Phone:347-669-0017
Mailing Address - Fax:
Practice Address - Street 1:185 OCEAN AVE # 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4763
Practice Address - Country:US
Practice Address - Phone:347-669-0017
Practice Address - Fax:347-669-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04658779Medicaid