Provider Demographics
NPI:1790825099
Name:ORTIZ TULLA, DOROTHT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHT
Middle Name:
Last Name:ORTIZ TULLA
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:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0525
Mailing Address - Country:US
Mailing Address - Phone:718-983-9570
Mailing Address - Fax:718-983-0348
Practice Address - Street 1:29 BRIELLE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6423
Practice Address - Country:US
Practice Address - Phone:718-983-9570
Practice Address - Fax:718-983-0348
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2219352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3X1422Medicare ID - Type Unspecified