Provider Demographics
NPI:1508942632
Name:ULTRAMEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ULTRAMEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-598-2929
Mailing Address - Street 1:7374 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9599
Mailing Address - Country:US
Mailing Address - Phone:585-598-2929
Mailing Address - Fax:585-598-2920
Practice Address - Street 1:7374 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9599
Practice Address - Country:US
Practice Address - Phone:585-598-2929
Practice Address - Fax:585-598-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO170059UMOtherBLUE CROSS BLUE SHIELD
NY7189627OtherAETNA
NY02621790Medicaid
NY892281OtherMVP HEALTHCARE
NY135419GHOtherPREFERRED CARE
NYPO170059UMOtherBLUE CROSS BLUE SHIELD