Healthcare Provider Details

I. General information

NPI: 1063534543
Provider Name (Legal Business Name): SETH MICHAEL ULANET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BARBERRY DR
OCEAN NJ
07712-8553
US

IV. Provider business mailing address

65 BARBERRY DR
OCEAN NJ
07712-8553
US

V. Phone/Fax

Practice location:
  • Phone: 732-493-2539
  • Fax:
Mailing address:
  • Phone: 732-493-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number25MAO2581200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: