Ortiz, Thomas R

Ortiz, Thomas R is an individual health care provider with primary practice located at 465 Mt. Prospect Ave. , Newark NJ 07104. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ortiz, Thomas R can be contacted via phone (973) 483-3640.

Contact Information

Primary practice address
465 Mt. Prospect Ave. Newark NJ 07104
Phone: (973) 483-3640
Fax: (973) 483-0132
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MA 40692 New Jersey

Profile Details

NPI number 1750312450
LBN Legal business name Ortiz, Thomas R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Mar 3rd, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750312450 NPPES
New Jersey Other 033691BXB MEDICARE GROUP SUFFIX
New Jersey MEDICAID 1259202 MEDICARE GROUP SUFFIX
New Jersey Other 527732 MEDICARE GROUP SUFFIX

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