Organization
PROMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TELISHA ORTIZ M.D. (PHYSICIAN OWNER)
(832) 567-1808
Entity
Organization
Contact information
Practice address
608 BERKLEY ST, CAMDEN, NJ 08103-1414
(832) 567-1808
Mailing address
5058 CITY LINE AVE, PHILADELPHIA, PA 19131-1441
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
MD456019
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306257001
—
PA
Enumeration date
09/13/2016
Last updated
09/13/2016
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