Provider Demographics
NPI:1902895998
Name:ULISS, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:ULISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:11011 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4946
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:11375-4946
Practice Address - Country:US
Practice Address - Phone:718-575-8434
Practice Address - Fax:718-575-3079
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147329207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00915119Medicaid
NY111660101OtherHEALTHPLUS
NY147329-A14OtherHEALTHFIRST
NY147329SOtherHEALTHCARE PARTNERS
NY1000000873OtherAFFINITY
NY1939885104OtherFIDELIS
NY370967OtherUNITED HEALTHCARE
NY112978266Other1199
NY267106006OtherCIGNA
NY41D702OtherBLUE CROSS BLUE SHIELD
NY0801043OtherUNITED HEALTHCARE MC MD
NY131352OtherWELLCARE
NY14756OtherAETNA
NYFIDELISOther040426017261
NY4C8501OtherHEALTHNET
NYDS378OtherOXFORD
NY9578OtherGHI
NY370967OtherUNITED HEALTHCARE
NY00915119Medicaid
NYC09644Medicare UPIN