Healthcare Provider Details

I. General information

NPI: 1992634513
Provider Name (Legal Business Name): LARRY J ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E RTE 4 STE 100
PARAMUS NJ
07652-2647
US

IV. Provider business mailing address

80 E RTE 4 STE 100
PARAMUS NJ
07652-2647
US

V. Phone/Fax

Practice location:
  • Phone: 201-845-3000
  • Fax: 201-843-2035
Mailing address:
  • Phone: 201-845-3000
  • Fax: 201-843-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02407700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: