Healthcare Provider Details

I. General information

NPI: 1104080589
Provider Name (Legal Business Name): ROSEMARY ORTIZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-7326
  • Fax: 212-717-3325
Mailing address:
  • Phone: 212-639-7326
  • Fax: 212-717-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22525884
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33334742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: