Provider Demographics
NPI:1740239854
Name:ULTEE, REINIER F (MD)
Entity Type:Individual
Prefix:
First Name:REINIER
Middle Name:F
Last Name:ULTEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MARGARET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1874
Mailing Address - Country:US
Mailing Address - Phone:518-314-3939
Mailing Address - Fax:518-314-3940
Practice Address - Street 1:159 MARGARET ST STE 100
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1874
Practice Address - Country:US
Practice Address - Phone:518-314-3939
Practice Address - Fax:518-314-3940
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166346207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01029107Medicaid
B80794Medicare UPIN
NY01029107Medicaid