Provider Demographics
NPI:1245585975
Name:ABELEDA, ALICIA ORTILLO (BSN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ORTILLO
Last Name:ABELEDA
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SEAVIEW AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1716
Mailing Address - Country:US
Mailing Address - Phone:201-683-1230
Mailing Address - Fax:
Practice Address - Street 1:68-80 SCHERMERHORN ST.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-858-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265956-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse