1992051163 NPI number — CHARLES HENRY ULRICH M.D.

Table of content: CHARLES HENRY ULRICH M.D. (NPI 1992051163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992051163 NPI number — CHARLES HENRY ULRICH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULRICH
Provider First Name:
CHARLES
Provider Middle Name:
HENRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992051163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 EAST 80TH STREET
Provider Second Line Business Mailing Address:
#11D
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-879-1752
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110-00 ROCKAWAY BLVD.
Provider Second Line Business Practice Location Address:
THE NEW YORK RACING ASSOCIATION, INC
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-659-2361
Provider Business Practice Location Address Fax Number:
718-659-3592
Provider Enumeration Date:
07/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  6-107758 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)