Individual
THOMAS R ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
465 MT. PROSPECT AVE., NEWARK, NJ 07104
(973) 483-3640
(973) 483-0132
Mailing address
465 MT. PROSPECT AVE., NEWARK, NJ 07104
(973) 483-3640
(973) 483-0132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA 40692
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033691BXB
MEDICARE GROUP SUFFIX
NJ
05
—
1259202
—
NJ
01
—
527732
MEDICARE GROUP
NJ
Enumeration date
07/05/2006
Last updated
03/03/2012
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