Healthcare Provider Details

I. General information

NPI: 1306576046
Provider Name (Legal Business Name): CAMILA ORTIZ GORRAIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILA ORTIZ MD

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17-17 ROUTE 208 FL 2
FAIR LAWN NJ
07410-2820
US

IV. Provider business mailing address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA13194600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: