Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 24834 | NY |
NPI | 1003129768 |
---|---|
Provider Name | Mr. Dennis Ortiz SR. |
First Address | Bronx, NY 10461 |
Second Address | Bronx, NY 10461-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2010 |
Last Update Date | 23/07/2010 |