Provider Demographics
NPI:1801352513
Name:ORTIZ, LAINEY JOANNE (PA-C)
Entity type:Individual
Prefix:
First Name:LAINEY
Middle Name:JOANNE
Last Name:ORTIZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 NJ-18
Mailing Address - Street 2:SUITE E
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-1883
Mailing Address - Fax:
Practice Address - Street 1:28 N PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1622
Practice Address - Country:US
Practice Address - Phone:848-444-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00514400363A00000X
NY023267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant