Provider Demographics
NPI:1346262391
Name:ORTANEZ, CORAZON M (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:M
Last Name:ORTANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BATTERY HILL DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2902
Mailing Address - Country:US
Mailing Address - Phone:856-767-8337
Mailing Address - Fax:
Practice Address - Street 1:907 N MAIN RD
Practice Address - Street 2:BUILDING C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8200
Practice Address - Country:US
Practice Address - Phone:856-692-3309
Practice Address - Fax:856-692-4155
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02778400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ199397Medicare ID - Type Unspecified
NJE13260Medicare UPIN