Healthcare Provider Details

I. General information

NPI: 1659442051
Provider Name (Legal Business Name): J&D ULTRACARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

IV. Provider business mailing address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax: 845-357-5039
Mailing address:
  • Phone: 845-357-4500
  • Fax: 845-357-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberD732L001
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00887527
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier0732L001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNY STATE DOH LICENSE

VIII. Authorized Official

Name: JENNIFER RAE
Title or Position: VICE PRESIDENT
Credential:
Phone: 845-357-4500