1861534398 NPI number — SAM L UNTERRICHT, MD, PC

Table of content: (NPI 1861534398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861534398 NPI number — SAM L UNTERRICHT, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM L UNTERRICHT, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAM L UNTERRICHT, MD
Provider Other Organization Name Type Code:
5
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:
1861534398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 ERICK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEWLETT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11557-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-569-4976
Provider Business Mailing Address Fax Number:
516-569-4865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PLAZA ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238-4955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-622-5800
Provider Business Practice Location Address Fax Number:
718-622-5832
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
UNTERRICHT
Authorized Official First Name:
SAM
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-622-5800

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  131659 , 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)

  • Identifier: 32A322 . This is a "WELL CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OC 1691 . This is a "TOUCHSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131659A16 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 175878 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 60519752 . This is a "FIDELIS CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00487581 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57819 . This is a "CARE PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: KS854 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OC 1691 . This is a "ACS HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2710000101 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4233294 . This is a "AETNA MC NAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0022985 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 26054P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32A322 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17P0841 . This is a "NY PRESBYTERIAN COMMUNITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 64572 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P0000003602 . This is a "GHI HMO MEDICARE VALUE" identifier . This identifiers is of the category "OTHER".




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