Healthcare Provider Details

I. General information

NPI: 1558785238
Provider Name (Legal Business Name): ULTRA MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23A WALKER WAY
ALBANY NY
12205-4945
US

IV. Provider business mailing address

1685 E 21ST ST
BROOKLYN NY
11210-5065
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-7555
  • Fax: 718-305-7224
Mailing address:
  • Phone: 718-796-7555
  • Fax: 718-305-7224

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: MR. SIMCHA HYMAN
Title or Position: OWNER
Credential:
Phone: 718-796-7555