Basic Information
| Provider Information | |||||||||
| NPI: | 1760598650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNGERER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MORROW | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 FOOTE AVE | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147016947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163389500 | ||||||||
| FaxNumber: | 7163389250 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 FOOTE AVE | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147016947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163389500 | ||||||||
| FaxNumber: | 7163389250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 110523 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00622564 | 05 | NY | MEDICAID |