Healthcare Provider Details

I. General information

NPI: 1871634006
Provider Name (Legal Business Name): JAIME LUIS CORTES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 BROADWAY
NEW YORK NY
10033-3726
US

IV. Provider business mailing address

6645 BROADWAY APT. 5H
BRONX NY
10471-2042
US

V. Phone/Fax

Practice location:
  • Phone: 212-923-2173
  • Fax:
Mailing address:
  • Phone: 718-548-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number175956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: