Provider Demographics
NPI:1679727564
Name:ORTIZ, JOSE A JR (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 POWERS ST
Mailing Address - Street 2:1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4842
Mailing Address - Country:US
Mailing Address - Phone:413-687-5899
Mailing Address - Fax:
Practice Address - Street 1:110 LIVINGSTON ST
Practice Address - Street 2:7F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5011
Practice Address - Country:US
Practice Address - Phone:413-687-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00587200235Z00000X
NY018749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist