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General NPI Number Information
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NPI Number | 1194326983
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Entity Type | Organization
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Legal Business Name | BLUE SPECTRUM FAMILY HEALTH NP PLLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 2 OCEAN DR APT W09F
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City | BROOKLYN
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State | NY
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Zip | 11224-3768
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Country | US
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Telephone | 718-200-8094
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Fax | 718-228-3868
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Provider Business Mailing Address
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Address Line | 13201 ROOSEVELT AVE PMB 818149
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City | FLUSHING
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State | NY
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Zip | 11354-5258
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Country | US
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Telephone | 718-200-8094
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Fax | 718-228-3868
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Authorized Official
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Title or Position | BUSINESS OWNER/FAMILY HEALTH NP
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Name | DR. JUAN CARLOS ORTIZ CALCANO
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Credential | DNP, FNP-BC
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Telephone | 718-200-8094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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