Provider Demographics
NPI:1740510304
Name:ALAN E ULISS MD PC
Entity type:Organization
Organization Name:ALAN E ULISS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ULISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-575-8434
Mailing Address - Street 1:11011 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4910
Mailing Address - Country:US
Mailing Address - Phone:718-575-8434
Mailing Address - Fax:718-575-3079
Practice Address - Street 1:11011 72ND AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4910
Practice Address - Country:US
Practice Address - Phone:718-575-8434
Practice Address - Fax:718-575-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00915119Medicaid
NY040426017261OtherFIDELIS
NY1000000873OtherAFFINITY
NY159940OtherELDERPLAN
NY267106006OtherCIGNA
NY44607POtherHIP
NY9578OtherGHI
NY111660101OtherHEALTHPLUS
NYOH4190OtherHEALTHNET
NY147329SOtherHEALTHCARE PARTNERS
NY3467528Other1199
NYDS378OtherOXFORD
NY14756OtherAETNA
NY370967OtherUNITED HEALTHCARE
NY41D702OtherBLUE CROSS BLUE SHIELD
NY100037096701OtherAMERICHOICE
NY131352OtherWELLCARE
NY147329-B14OtherHEALTHFIRST
NY801043OtherUNITED HEALTHCARE MC
NY00915119Medicaid