Healthcare Provider Details

I. General information

NPI: 1053009076
Provider Name (Legal Business Name): ANGELA ORTIZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 149TH ST
BRONX NY
10451-5602
US

IV. Provider business mailing address

311 E 175TH ST
BRONX NY
10457-5859
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-4300
  • Fax: 718-947-2257
Mailing address:
  • Phone: 718-960-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: