Healthcare Provider Details

I. General information

NPI: 1790783355
Provider Name (Legal Business Name): JEROME J ULATOWSKI II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6937 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

IV. Provider business mailing address

6937 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

V. Phone/Fax

Practice location:
  • Phone: 716-298-1107
  • Fax: 716-298-5737
Mailing address:
  • Phone: 716-298-1107
  • Fax: 716-298-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159192
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number159192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: