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
- 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 |
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": []
}Other providers in Port Orange, FL
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.