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General NPI Number Information
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NPI Number | 1598766248
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Entity Type | Individual
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Provider Name | LISA ANN ORTENZIO OD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 20 E 46TH ST PENTHOUSE
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City | NEW YORK
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State | NY
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Zip | 10017-2417
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Country | US
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Telephone | 212-353-0030
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Fax | 212-353-0083
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Provider Business Mailing Address
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Address Line | 20 E 46TH ST PENTHOUSE
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City | NEW YORK
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State | NY
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Zip | 10017-2417
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Country | US
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Telephone | 212-353-0030
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Fax | 212-353-0083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27AO00548000
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License Number State | NJ
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