Provider Demographics
NPI:1467852103
Name:ULTRA MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ULTRA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:EZRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-796-7555
Mailing Address - Street 1:7921 GRAYSON RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5419
Mailing Address - Country:US
Mailing Address - Phone:718-796-7555
Mailing Address - Fax:516-566-2395
Practice Address - Street 1:7921 GRAYSON RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5419
Practice Address - Country:US
Practice Address - Phone:718-796-7555
Practice Address - Fax:516-566-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1466586332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028914120001Medicaid