Provider Demographics
NPI:1578725073
Name:OLIVIA T. ORTIZ MD PA
Entity Type:Organization
Organization Name:OLIVIA T. ORTIZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARICIEL
Authorized Official - Middle Name:ORTIZ
Authorized Official - Last Name:GATPOLINTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-505-4007
Mailing Address - Street 1:1163 ROUTE 37 W
Mailing Address - Street 2:SUITE A-1
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 A-1
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07561700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069535Medicare PIN