Provider Demographics
NPI:1306955547
Name:UNGAR, STEPHAN E (PT)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:E
Last Name:UNGAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 WAVERLY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1597
Mailing Address - Country:US
Mailing Address - Phone:631-758-5700
Mailing Address - Fax:631-758-7005
Practice Address - Street 1:440 WAVERLY AVE STE 5
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1597
Practice Address - Country:US
Practice Address - Phone:631-758-5700
Practice Address - Fax:631-758-7005
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011026-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY139551POtherHIP
14378140OtherFIRST HEALTH
NY2788OtherHERITAGE
P1939994OtherOXFORD
NY43641478OtherAETNA
NY65002050OtherRAIL ROAD MEDICARE
NY102481OtherVYTRA
NYSF0003105OtherSELECT PRO
NY2287876OtherAETNA
NY11350404040OtherNO FAULT
NY1259717OtherUNITED HEALTH CARE
NYQ86011OtherEMPIRE BLUE CROSS / SHIEL
NYAZ00653OtherMDNY
NYAZ00653OtherMDNY