MEDICARE: JUAN ORTIZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1851835946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN ORTIZ

Provider Business Mailing Address
First Line	:	9 FARGO CT
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-1506
Country	:	US
Telephone Number	:	631-394-0931
Fax Number	:

Provider Business Practice Location Address
First Line	:	1162 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3332
Country	:	US
Telephone Number	:	631-394-0931
Fax Number	:

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

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/08/2016

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Directions to “ JUAN ORTIZ ” Practice Location

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