Provider Demographics
NPI:1750649810
Name:ORTIZ, KRYSTL GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTL
Middle Name:GEORGE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRYSTL
Other - Middle Name:S
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:516 MAIN ST STE 23
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6820
Mailing Address - Country:US
Mailing Address - Phone:318-617-2761
Mailing Address - Fax:
Practice Address - Street 1:1481 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4667
Practice Address - Country:US
Practice Address - Phone:929-491-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67497208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty