Healthcare Provider Details

I. General information

NPI: 1790640498
Provider Name (Legal Business Name): MARK ORDONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 SAINT NICHOLAS AVE
BROOKLYN NY
11237-4838
US

IV. Provider business mailing address

199 SAINT NICHOLAS AVE
BROOKLYN NY
11237-4838
US

V. Phone/Fax

Practice location:
  • Phone: 929-299-6505
  • Fax: 718-799-9191
Mailing address:
  • Phone: 929-299-6505
  • Fax: 718-799-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: