Healthcare Provider Details

I. General information

NPI: 1306986815
Provider Name (Legal Business Name): CELINA R ORTIZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST BOX 124
NEW YORK NY
10021-4870
US

IV. Provider business mailing address

525 E 68TH ST BOX 124
NEW YORK NY
10021-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2846
  • Fax: 212-746-8108
Mailing address:
  • Phone: 212-746-2846
  • Fax: 212-746-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number583565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: