1043514615 NPI number — URBAN HEALTH PLAN, INC.

Table of content: ZEESHAN SARWAR AZIZ M.D. (NPI 1851512990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043514615 NPI number — URBAN HEALTH PLAN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URBAN HEALTH PLAN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELLA VISTA COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043514615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 SOUTHERN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10459-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-589-2440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
882 HUNTS POINT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10474-5402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-589-2440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DELEON
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP MEDICAL AFFAIRS/CMO
Authorized Official Telephone Number:
718-589-2440

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 331016 . This is a "FACILITY MEDICARE ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02994952 . This is a "GROUP MEDICAID ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03410166 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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