MEDICARE: ELIZA ORTIZ P.T.

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
1	174400000X	Specialist	017905	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225162852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZA ORTIZ P.T.

Provider Business Mailing Address
First Line	:	2014 WILLIAMSBRIDGE ROAD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	718-239-4314
Fax Number	:	718-239-4315

Provider Business Practice Location Address
First Line	:	2014 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1603
Country	:	US
Telephone Number	:	718-239-4314
Fax Number	:	718-239-4315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	03/16/2008

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