Provider Demographics
NPI:1649352212
Name:UNGERLAND, MICHAEL J (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:UNGERLAND
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 COLUMBIA ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534
Mailing Address - Country:US
Mailing Address - Phone:518-751-1016
Mailing Address - Fax:518-751-1020
Practice Address - Street 1:71 PROSPECT AVE
Practice Address - Street 2:COLUMBIA MEMORIAL HOSPITAL
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534
Practice Address - Country:US
Practice Address - Phone:518-828-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009969363A00000X
NY0099691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02618073Medicaid
NY5425L17821Medicare PIN
NYQ14914Medicare UPIN