Provider Demographics
NPI:1932314085
Name:ULLMAN, REISA FRAN (MD)
Entity Type:Individual
Prefix:
First Name:REISA
Middle Name:FRAN
Last Name:ULLMAN
Suffix:
Gender:F
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:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-0819
Mailing Address - Country:US
Mailing Address - Phone:516-869-8982
Mailing Address - Fax:
Practice Address - Street 1:297 MINEOLA BLVD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-741-2772
Practice Address - Fax:516-294-5574
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152243207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01463818Medicaid
A96933Medicare UPIN
NY02E241Medicare PIN