Active NPI
Malgorzata Ptak
- Assisted Living Facility
- Port Orange, FL
National Provider Identifier
1295299451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- AL5650
- Practice address
- 158 Farmbrook Rd
Port Orange, FL 32127-6243 - Phone
- (386) 767-1613
- NPI assigned
- Jan 22, 2019
- Last updated
- Jan 22, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL5650 | FL | Primary |
Addresses
Primary practice location
158 Farmbrook Rd
Port Orange, FL 32127-6243
Mailing address
158 Farmbrook Rd
Port Orange, FL 32127-6243
Phone (386) 767-1613
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 |
|---|---|---|---|
| AL5650 | FL | MD | Assisted Living Facility |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1295299451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "158 FARMBROOK RD",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321276243",
"telephone_number": "386-767-1613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 FARMBROOK RD",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321276243",
"telephone_number": "386-767-1613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PTAK",
"first_name": "MALGORZATA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-22",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "FL",
"license": "AL5650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.