Organization
URBAN HEALTH PLAN, INC.
Active
Organization
URBAN HEALTH PLAN, INC.
Active
Parent organization
KIPS BAYS BOYS AND GIRLS CLUB/CREST SMILE SHOPPE DENTAL CLINIC
Other names
KIPS BAYS BOYS AND GIRLS CLUB/CREST SMILE SHOPPE DENTAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIPS BAYS BOYS AND GIRLS CLUB/CREST SMILE SHOPPE DENTAL CLINIC
Authorized official
SAMUEL DELEON MD (VP MEDICAL AFFAIRS/CMO)
(718) 589-2440
Entity
Organization
Contact information
Practice address
1930 RANDALL AVE, BRONX, NY 10473-2608
(718) 893-2600
Mailing address
1065 SOUTHERN BLVD, BRONX, NY 10459-2417
(718) 589-2440
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02994952
—
NY
Enumeration date
04/07/2011
Last updated
04/07/2011
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