Provider Demographics
NPI:1396739603
Name:CORTIJO, AMARILYS (MD)
Entity type:Individual
Prefix:
First Name:AMARILYS
Middle Name:
Last Name:CORTIJO
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 1:130 W TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5436
Mailing Address - Country:US
Mailing Address - Phone:718-583-9000
Mailing Address - Fax:718-583-2835
Practice Address - Street 1:130 W TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5436
Practice Address - Country:US
Practice Address - Phone:718-583-9000
Practice Address - Fax:718-583-2835
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903700Medicaid
NY2540A1Medicare ID - Type Unspecified
NY00903700Medicaid