1205460441 NPI number — ULTRACARE FAMILY WELLNESS OF NY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205460441 NPI number — ULTRACARE FAMILY WELLNESS OF NY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ULTRACARE FAMILY WELLNESS OF NY, INC.
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:
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:
1205460441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 FRONT ST
Provider Second Line Business Mailing Address:
UNIT 9 AND UNIT 13
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11201-1154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-238-4857
Provider Business Mailing Address Fax Number:
718-535-2773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 FRONT ST
Provider Second Line Business Practice Location Address:
UNIT 9 AND UNIT 13
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-238-4857
Provider Business Practice Location Address Fax Number:
718-535-2773
Provider Enumeration Date:
02/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
NUR
Authorized Official First Name:
SUMYA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
347-809-1363

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07633163 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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