Provider Demographics
NPI:1992847552
Name:UNTERRICHT, SAM L (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:L
Last Name:UNTERRICHT
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 1:23 ERICK AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1408
Mailing Address - Country:US
Mailing Address - Phone:516-569-4976
Mailing Address - Fax:516-569-4865
Practice Address - Street 1:20 PLAZA ST E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4955
Practice Address - Country:US
Practice Address - Phone:718-622-5800
Practice Address - Fax:718-622-5832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131659207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00487581Medicaid
NY32A32Medicare ID - Type UnspecifiedEMPIRE MEDICARE
B12913Medicare UPIN