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NPI Code Detail

MEDICARE: GERALD ORTEGO PA-C

MEDICARE:   GERALD  ORTEGO  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant002129NY

General Provider Information

NPI Number : 1144379884
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD ORTEGO PA-C
Provider Business Mailing Address
First Line : 192 W GENESEE ST
Second Line : LAKE REGION UROLOGY
City : AUBURN
State : NY
Zip : 13021-3361
Country : US
Telephone Number : 315-258-5253
Fax Number : 315-258-0202
Provider Business Practice Location Address
First Line : 192 W GENESEE ST
Second Line : LAKE REGION UROLOGY
City : AUBURN
State : NY
Zip : 13021-3361
Country : US
Telephone Number : 315-258-5253
Fax Number : 315-258-0202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 01/03/2013

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Directions to “ GERALD ORTEGO PA-C” Practice Location

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