1073597902 NPI number — YAEL A ORTIZ DDS

Table of content: YAEL A ORTIZ DDS (NPI 1073597902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073597902 NPI number — YAEL A ORTIZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ
Provider First Name:
YAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073597902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2265 THIRD AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10035-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-289-6650
Provider Business Mailing Address Fax Number:
212-289-0280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2265 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-289-6650
Provider Business Practice Location Address Fax Number:
212-289-0280
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  046385 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 521860379 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13058 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521860379 . This is a "DELTA DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG26TH521860379-2-00 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0017022 . This is a "DORAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054635 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119591300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288504201 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 521860379 . This is a "METLIFE" identifier . This identifiers is of the category "OTHER".




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