Healthcare Provider Details

I. General information

NPI: 1154515567
Provider Name (Legal Business Name): ULTIMATE ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 WHITE PLAINS RD
BRONX NY
10467
US

IV. Provider business mailing address

103 PIERSON AVE
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-9664
  • Fax: 718-944-1623
Mailing address:
  • Phone: 718-515-9664
  • Fax: 718-944-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BILLY H FORD
Title or Position: OWNER
Credential: MD
Phone: 718-515-9664