Provider Demographics
NPI:1740087683
Name:ULLRICH, ANTHONY XAVIER
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:XAVIER
Last Name:ULLRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2994
Mailing Address - Country:US
Mailing Address - Phone:516-724-0308
Mailing Address - Fax:
Practice Address - Street 1:201 DIXON AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2994
Practice Address - Country:US
Practice Address - Phone:516-724-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-P-7856175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist