Provider Demographics
NPI:1598298911
Name:ULTRA MEDICAL TECHNOLOGIES
Entity Type:Organization
Organization Name:ULTRA MEDICAL TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FAHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:516-647-7053
Mailing Address - Street 1:271 N DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1830
Mailing Address - Country:US
Mailing Address - Phone:516-647-7053
Mailing Address - Fax:
Practice Address - Street 1:271 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1830
Practice Address - Country:US
Practice Address - Phone:516-647-7053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies