Provider Demographics
NPI:1407828445
Name:ORTIZ, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2009
Mailing Address - Country:US
Mailing Address - Phone:973-361-5252
Mailing Address - Fax:973-361-6161
Practice Address - Street 1:249 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885
Practice Address - Country:US
Practice Address - Phone:973-361-5252
Practice Address - Fax:973-361-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06046500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF78302Medicare UPIN
NJ766325Medicare UPIN