Provider Demographics
NPI:1225191992
Name:ORTIZ, OLIVIA T (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:T
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1163 ROUTE 37 W
Mailing Address - Street 2:SUITE A1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4973
Mailing Address - Country:US
Mailing Address - Phone:732-505-4007
Mailing Address - Fax:732-736-8811
Practice Address - Street 1:1163 ROUTE 37 W
Practice Address - Street 2:SUITE A1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4973
Practice Address - Country:US
Practice Address - Phone:732-505-4007
Practice Address - Fax:732-736-8811
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07561700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
069535Medicare PIN