Healthcare Provider Details

I. General information

NPI: 1417097965
Provider Name (Legal Business Name): OSVALDO CORTINA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 38TH ST
UNION CITY NJ
07087-4845
US

IV. Provider business mailing address

322 38TH ST
UNION CITY NJ
07087-5283
US

V. Phone/Fax

Practice location:
  • Phone: 201-865-9492
  • Fax: 201-865-0306
Mailing address:
  • Phone: 201-865-9491
  • Fax: 201-865-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07689300
License Number StateNJ

VIII. Authorized Official

Name: DR. OSVALDO CORTINA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-865-9491