Active NPI
Angel Portorreal
- Licensed Practical Nurse
- Ridgewood, NY
National Provider Identifier
1033390703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 226755-1
- Practice address
- 1743 Summerfield St
Ridgewood, NY 11385-8113 - Phone
- (718) 795-7317
- NPI assigned
- Nov 21, 2007
- Reactivated
- Dec 18, 2023
- Last updated
- Dec 18, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 226755-1 | NY | Primary |
Addresses
Primary practice location
1743 Summerfield St
Ridgewood, NY 11385-8113
Mailing address
1743 Summerfield St
Ridgewood, NY 11385-8113
Phone (718) 795-7317
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02888622 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 226755-1 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702857600000",
"number": "1033390703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1743 SUMMERFIELD ST",
"city": "RIDGEWOOD",
"state": "NY",
"postal_code": "113858113",
"telephone_number": "718-795-7317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1743 SUMMERFIELD ST",
"city": "RIDGEWOOD",
"state": "NY",
"postal_code": "113858113",
"telephone_number": "718-795-7317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTORREAL",
"first_name": "ANGEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-21",
"last_updated": "2023-12-18",
"deactivation_date": "2023-11-27",
"reactivation_date": "2023-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "226755-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02888622",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.