Healthcare Provider Details

I. General information

NPI: 1790371607
Provider Name (Legal Business Name): RICHARD ORTEGA JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 05/21/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RESEARCH WAY STE 500
EAST SETAUKET NY
11733-3470
US

IV. Provider business mailing address

194 MISSOURI AVE
BAY SHORE NY
11706-4536
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-6270
  • Fax:
Mailing address:
  • Phone: 631-559-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: