Provider Demographics
NPI:1194875823
Name:URBANO, HERNAN ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:HERNAN
Middle Name:ANTONIO
Last Name:URBANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BOERUM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2636
Mailing Address - Country:US
Mailing Address - Phone:718-388-2262
Mailing Address - Fax:718-599-0935
Practice Address - Street 1:123 BOERUM ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2636
Practice Address - Country:US
Practice Address - Phone:718-388-2262
Practice Address - Fax:718-599-0935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
112401166OtherFEDERAL TAX ID
844041Medicare PIN
B79686Medicare UPIN