Provider Demographics
NPI:1871634006
Name:CORTES, JAIME LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LUIS
Last Name:CORTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 BROADWAY
Mailing Address - Street 2:APT. 5H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2042
Mailing Address - Country:US
Mailing Address - Phone:718-548-2072
Mailing Address - Fax:
Practice Address - Street 1:4260 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3726
Practice Address - Country:US
Practice Address - Phone:212-923-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175956170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01391280Medicaid
E87465Medicare UPIN