Provider Demographics
NPI:1497992291
Name:ULTIMATE MEDICAL CARE, PC
Entity Type:Organization
Organization Name:ULTIMATE MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-369-8000
Mailing Address - Street 1:912 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2732
Mailing Address - Country:US
Mailing Address - Phone:631-369-8000
Mailing Address - Fax:631-727-8562
Practice Address - Street 1:912 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2732
Practice Address - Country:US
Practice Address - Phone:631-369-8000
Practice Address - Fax:631-727-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242419-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty