Provider Demographics
NPI:1861534398
Name:SAM L UNTERRICHT, MD, PC
Entity type:Organization
Organization Name:SAM L UNTERRICHT, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:UNTERRICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-622-5800
Mailing Address - Street 1:23 ERICK AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1408
Mailing Address - Country:US
Mailing Address - Phone:516-569-4976
Mailing Address - Fax:516-569-4865
Practice Address - Street 1:20 PLAZA ST E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4955
Practice Address - Country:US
Practice Address - Phone:718-622-5800
Practice Address - Fax:718-622-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131659207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32A322OtherWELL CHOICE
OC 1691OtherTOUCHSTONE
131659A16OtherHEALTHFIRST
NY175878OtherELDERPLAN
60519752OtherFIDELIS CARE
NY00487581Medicaid
NY57819OtherCARE PLUS
NYKS854OtherOXFORD
OC 1691OtherACS HEALTH NET
NY2710000101OtherHEALTHPLUS
4233294OtherAETNA MC NAP
NY0022985OtherGROUP HEALTH INCORPORATED
NY26054POtherHIP
NY32A322OtherEMPIRE BLUE CROSS
NY17P0841OtherNY PRESBYTERIAN COMMUNITY
64572OtherAETNA
P0000003602OtherGHI HMO MEDICARE VALUE
NY32A322OtherEMPIRE BLUE CROSS
NY57819OtherCARE PLUS