Provider Demographics
NPI:1326027574
Name:ULTRAMEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:ULTRAMEDICAL SUPPLIES LLC
Other - Org Name:ULTRAMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGAROSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-473-3040
Mailing Address - Street 1:1465 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3149
Mailing Address - Country:US
Mailing Address - Phone:585-473-3040
Mailing Address - Fax:585-473-3045
Practice Address - Street 1:1465 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3149
Practice Address - Country:US
Practice Address - Phone:585-473-3040
Practice Address - Fax:585-473-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621790Medicaid
NY02621790Medicaid