Provider Demographics
NPI:1639299076
Name:ULRICH, ETHEL (NP)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MERRICK RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5254
Mailing Address - Country:US
Mailing Address - Phone:516-763-2800
Mailing Address - Fax:516-960-0299
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:SUITE 402
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-763-2800
Practice Address - Fax:516-960-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292275-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner