Healthcare Provider Details

I. General information

NPI: 1639299076
Provider Name (Legal Business Name): ETHEL ULRICH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MERRICK RD SUITE 402
ROCKVILLE CENTRE NY
11570-5254
US

IV. Provider business mailing address

242 MERRICK RD SUITE 402
ROCKVILLE CENTRE NY
11570-5254
US

V. Phone/Fax

Practice location:
  • Phone: 516-763-2800
  • Fax: 516-960-0299
Mailing address:
  • Phone: 516-763-2800
  • Fax: 516-960-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number292275-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: