Provider Demographics
NPI:1720348295
Name:ORTEGA, FELIX YOVANNY (PA)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:YOVANNY
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4104
Mailing Address - Country:US
Mailing Address - Phone:212-690-4002
Mailing Address - Fax:212-690-3264
Practice Address - Street 1:266 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4104
Practice Address - Country:US
Practice Address - Phone:212-690-4002
Practice Address - Fax:212-690-3264
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015556363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical