Provider Demographics
NPI:1831313949
Name:ORTEGA, LEONARDO (RPH)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KOSSUTH PL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3508
Mailing Address - Country:US
Mailing Address - Phone:973-305-1616
Mailing Address - Fax:
Practice Address - Street 1:357 TOTOWA AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-2125
Practice Address - Country:US
Practice Address - Phone:973-595-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03032600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist