Healthcare Provider Details

I. General information

NPI: 1780084210
Provider Name (Legal Business Name): ULTRA MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 ROUTE 59 BUILDING 268
AIRMONT NY
10952-3419
US

IV. Provider business mailing address

382 ROUTE 59 BUILDING 268
AIRMONT NY
10952-3419
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-7555
  • Fax: 516-566-2395
Mailing address:
  • Phone: 718-796-7555
  • Fax: 516-566-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1466586
License Number StateNY

VIII. Authorized Official

Name: EZRIEL UNGAR
Title or Position: CONTROLLER
Credential:
Phone: 718-796-7555