Provider Demographics
NPI:1427536838
Name:ORTALE, CRISTIN ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:ANNE
Last Name:ORTALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:ANNE
Other - Last Name:CIARAVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-5800
Mailing Address - Fax:
Practice Address - Street 1:609 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4540
Practice Address - Country:US
Practice Address - Phone:516-489-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant