MEDICARE: DR. JOSE E ORTIZ MD

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	207R00000X	Internal Medicine Physician	199442	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	:	1013124544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE E ORTIZ MD

Provider Business Mailing Address
First Line	:	7916 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6748
Country	:	US
Telephone Number	:	718-406-9111
Fax Number	:	718-406-9994

Provider Business Practice Location Address
First Line	:	7916 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6748
Country	:	US
Telephone Number	:	718-406-9111
Fax Number	:	718-406-9994

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/25/2020

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