MEDICARE: MR. RICARDO ORTEGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	003921	NY

General Provider Information

NPI Number	:	1265785166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICARDO ORTEGA

Provider Business Mailing Address
First Line	:	8155 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1728
Country	:	US
Telephone Number	:	646-382-4385
Fax Number	:

Provider Business Practice Location Address
First Line	:	8155 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1728
Country	:	US
Telephone Number	:	646-382-4385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	10/17/2012

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