Provider Demographics
NPI:1801972583
Name:POTKAY, URSULA C
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:C
Last Name:POTKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MILLTOWN RD
Mailing Address - Street 2:MILLBROOKE OFFICE CENTER SUITE 205
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509
Mailing Address - Country:US
Mailing Address - Phone:845-279-4404
Mailing Address - Fax:845-279-4404
Practice Address - Street 1:20 MILLTOWN RD
Practice Address - Street 2:MILLBROOKE OFFICE CENTER
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509
Practice Address - Country:US
Practice Address - Phone:845-279-4404
Practice Address - Fax:845-279-4404
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0391041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist