Provider Demographics
NPI:1619177243
Name:ORTOF, EDNA CHARLOTTE (PHD)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:CHARLOTTE
Last Name:ORTOF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HIGHLAND WAY
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1609
Mailing Address - Country:US
Mailing Address - Phone:914-725-2317
Mailing Address - Fax:
Practice Address - Street 1:17 HIGHLAND WAY
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1609
Practice Address - Country:US
Practice Address - Phone:914-725-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV59652Medicare PIN