Provider Demographics
NPI:1013124544
Name:ORTIZ, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:ORTIZ
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 1:7916 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6748
Mailing Address - Country:US
Mailing Address - Phone:718-406-9111
Mailing Address - Fax:718-406-9994
Practice Address - Street 1:7916 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6748
Practice Address - Country:US
Practice Address - Phone:718-406-9111
Practice Address - Fax:718-406-9994
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01583191Medicaid
NY01583191Medicaid
G05041Medicare UPIN