Healthcare Provider Details

I. General information

NPI: 1730690892
Provider Name (Legal Business Name): JACQUELINE ORTEGA BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 WASHINGTON ST. PROS 2ND FLOOR
MOUNT VERNON NY
10553
US

IV. Provider business mailing address

256 WASHINGTON ST STE 2
MOUNT VERNON NY
10553-1056
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax: 914-664-8189
Mailing address:
  • Phone: 914-613-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number532135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: