MEDICARE: DR. KRYSTL GEORGE ORTIZ M.D.

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	208D00000X	General Practice Physician	67497	CT

General Provider Information

NPI Number	:	1750649810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTL GEORGE ORTIZ M.D.

Provider Business Mailing Address
First Line	:	516 MAIN ST STE 23
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-6820
Country	:	US
Telephone Number	:	318-617-2761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1481 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4667
Country	:	US
Telephone Number	:	929-491-7700
Fax Number	:

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	09/18/2024

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