Provider Demographics
NPI:1982758066
Name:URBAN HEALTH PLAN, INC.
Entity type:Organization
Organization Name:URBAN HEALTH PLAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MANAGED CARE OFFICE, CONT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-589-2440
Mailing Address - Street 1:1065 SOUTHERN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2417
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:890 HUNTS POINT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5402
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:718-589-4793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA VISTA HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244977Medicaid
NY02994952-00244977Medicaid
NY02994952-00244977Medicaid