Provider Demographics
NPI:1609131135
Name:ORTEGA, JORGE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1702
Mailing Address - Country:US
Mailing Address - Phone:914-474-6605
Mailing Address - Fax:
Practice Address - Street 1:1234 SUMMER ST STE 101
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5521
Practice Address - Country:US
Practice Address - Phone:203-359-8326
Practice Address - Fax:203-352-1912
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist