Provider Demographics
NPI:1871694737
Name:URBAN, MICHAEL OPINIANO (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OPINIANO
Last Name:URBAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14021 32ND AVE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2613
Mailing Address - Country:US
Mailing Address - Phone:718-224-1600
Mailing Address - Fax:718-224-8085
Practice Address - Street 1:14021 32ND AVE
Practice Address - Street 2:SUITE C1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2613
Practice Address - Country:US
Practice Address - Phone:718-224-1600
Practice Address - Fax:718-224-8085
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid