Provider Demographics
NPI:1740723329
Name:ORTIZ, CHRISTY (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 OCONNOR RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2515
Mailing Address - Country:US
Mailing Address - Phone:631-374-2595
Mailing Address - Fax:
Practice Address - Street 1:309 OCONNOR RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2515
Practice Address - Country:US
Practice Address - Phone:631-374-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324231-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse