Provider Demographics
NPI:1578826285
Name:ORTIZ, ANGIE M
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E STONE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1903
Mailing Address - Country:US
Mailing Address - Phone:845-562-2535
Mailing Address - Fax:845-562-2535
Practice Address - Street 1:509 WILLIS AVE FL 5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4001
Practice Address - Country:US
Practice Address - Phone:347-571-2179
Practice Address - Fax:718-585-4857
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17M0000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator