Provider Demographics
NPI:1174731855
Name:URBAN RESOURCE INSTITUE
Entity type:Organization
Organization Name:URBAN RESOURCE INSTITUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-260-2900
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-0450
Mailing Address - Country:US
Mailing Address - Phone:212-491-0023
Mailing Address - Fax:
Practice Address - Street 1:539 W 152ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1601
Practice Address - Country:US
Practice Address - Phone:212-491-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYM592240251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5404360OtherLMSW