Provider Demographics
NPI:1891422648
Name:ORTIZ, MICHAEL OLIVER (NP IN PSYCHIATRY)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OLIVER
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:NP IN PSYCHIATRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3789 RIVERS POINTE WAY APT 14
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-4939
Mailing Address - Country:US
Mailing Address - Phone:917-667-9465
Mailing Address - Fax:
Practice Address - Street 1:713 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2305
Practice Address - Country:US
Practice Address - Phone:315-464-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404282363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health