MEDICARE: J&D ULTRACARE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	251E00000X	Home Health Agency	D732L001	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0732L001	OTHER	NY	NY STATE DOH LICENSE

General Provider Information

NPI Number	:	1659442051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J&D ULTRACARE CORP

Provider Business Mailing Address
First Line	:	15 SUFFERN PL STE A
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-5566
Country	:	US
Telephone Number	:	845-357-4500
Fax Number	:	845-357-5039

Provider Business Practice Location Address
First Line	:	15 SUFFERN PL STE A
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-5566
Country	:	US
Telephone Number	:	845-357-4500
Fax Number	:	845-357-5039

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JENNIFER RAE
Credential	:
Telephone Number	:	845-357-4500

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	12/08/2020

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Directions to “J&D ULTRACARE CORP ” Practice Location

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