Provider Demographics
NPI:1700215415
Name:ORDONEZ, LISBETH SUSAN (RN)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:SUSAN
Last Name:ORDONEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2133
Mailing Address - Country:US
Mailing Address - Phone:631-245-0541
Mailing Address - Fax:
Practice Address - Street 1:28 HENRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2133
Practice Address - Country:US
Practice Address - Phone:631-245-0541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674860-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY674860-1Medicaid